Provider Demographics
NPI:1922463611
Name:M.L.S. MD,LLC
Entity Type:Organization
Organization Name:M.L.S. MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-441-9488
Mailing Address - Street 1:10995 CHASE PARK LN APT C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5787
Mailing Address - Country:US
Mailing Address - Phone:314-695-5529
Mailing Address - Fax:314-695-5529
Practice Address - Street 1:10995 CHASE PARK LN APT C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5787
Practice Address - Country:US
Practice Address - Phone:314-695-5529
Practice Address - Fax:314-695-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1164598579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1164598579OtherINDIVIDUAL NPI