Integrated Medical Group, LLC
General Practice in Saint Louis, MO. Organization (NPI-2).
NPI number1265327076
StatusActive
Last updated in NPPESJun 11, 2025
Details
- NPI
- 1265327076
- Entity type
- Organization (NPI-2)
- Legal business name
- Integrated Medical Group, LLC
- Organization subpart
- No
- Enumeration date
- Jun 11, 2025
- Certification date
- Jun 11, 2025
- Last updated
- Jun 11, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Practice location
6155 S Grand Blvd Ste 140Saint Louis, MO 63111-2319
Phone 314-526-6093
Mailing address
6155 S Grand Blvd Ste 140Saint Louis, MO 63111-2319
Phone 314-526-6093
Authorized official
Mitchell Liberman
Manager
3143743408
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