Provider Demographics
NPI:1144577057
Name:PRECISION PLASTIC SURGERY, PC ST. PETERS OFFICE
Entity Type:Organization
Organization Name:PRECISION PLASTIC SURGERY, PC ST. PETERS OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-922-5575
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 260A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:636-922-5575
Mailing Address - Fax:
Practice Address - Street 1:70 JUNGERMANN CIRCLE, STE 302
Practice Address - Street 2:
Practice Address - City:ST. PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:314-843-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECISION PLASTIC SURGERY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty