Provider Demographics
NPI:1700980380
Name:ATC, LLC
Entity Type:Organization
Organization Name:ATC, LLC
Other - Org Name:LYNETTE SANTOS MALIK, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-576-2490
Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:ATTN RICK SONNE
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3417
Mailing Address - Country:US
Mailing Address - Phone:314-576-2491
Mailing Address - Fax:314-336-5205
Practice Address - Street 1:121 SAINT LUKES CENTER DR
Practice Address - Street 2:STE 504
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-576-2334
Practice Address - Fax:314-590-5944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKE'S MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015185Medicare PIN