Provider Demographics
NPI:1548203268
Name:LENZ, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16207 BEAR BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-7003
Mailing Address - Country:US
Mailing Address - Phone:636-527-2283
Mailing Address - Fax:636-527-2283
Practice Address - Street 1:1400 US HWY 61 SOUTH
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-933-1111
Practice Address - Fax:636-933-1030
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002008832207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00225149OtherRAILROAD MEDICARE
MO1548203268Medicaid
MO426403OtherHEALTHLINK
MO124884OtherBLUE CROSS
MO947071631OtherMERCYHEALTH
MO205819527Medicaid
MO426403OtherHEALTHLINK
MOF67897Medicare UPIN
MO920895005Medicare PIN
IL216097003Medicare PIN
MO947071631OtherMERCYHEALTH
MO920891631Medicare ID - Type Unspecified
MO132130003Medicare PIN
ILP00694327Medicare PIN
MO026013211Medicare PIN
MOP00225149OtherRAILROAD MEDICARE
MO030013210Medicare PIN