Organization
LAKEVIEW MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS F WRIGHT (PRESIDENT)
(636) 397-4012
Entity
Organization
Contact information
Practice address
830 WATERBURY FALLS DR, STE 202, O FALLON, MO 63368-2215
(636) 278-1670
Mailing address
1630 MARKET CENTER BLVD STE 201, O FALLON, MO 63368-8407
(636) 397-4012
(636) 278-1670
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
108025
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000013627
MEDICARE GROUP PTAN
MO
Enumeration date
04/23/2007
Last updated
11/05/2021
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