Provider Demographics
NPI:1518935568
Name:PEICK, ANN LUTZEIER (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:LUTZEIER
Last Name:PEICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:621 S. NEW BALLAS RD.
Mailing Address - Street 2:SUITE 560A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6440
Mailing Address - Fax:314-251-4456
Practice Address - Street 1:621 S. NEW BALLAS RD.
Practice Address - Street 2:SUITE 560A
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6440
Practice Address - Fax:314-251-4456
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6D372086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO113818OtherBLUE CROSS BLUE SHIELD
46291V11170OtherHEALTHCARE USA
MO50809OtherGHP
710444OtherMERCY HEALTH PLAN
MO202330429Medicaid
50809OtherGROUP HEALTH PLAN
MO020043388OtherRAILROAD MEDICARE
MO142383OtherHEALTHLINK
MO142383OtherHEALTHLINK
MOAP2494259OtherDEA
46291V11170OtherHEALTHCARE USA
MO000094055Medicare PIN