NPIMap

Organization Active NPI

Lake Mi Mobile Doctors, P.C.

Doing business as Mobile Doctors of St. Louis

  • Geriatric Medicine (Internal Medicine) Physician
  • Saint Louis, MO
National Provider Identifier
1992057566
Registry record updated Oct 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
LAKE MI MOBILE DOCTORS, P.C.
Doing business as
Mobile Doctors of St. Louis
Practice address
10016 Office Center Ave
Suite 100
Saint Louis, MO 63128-1468
Phone
(314) 720-0855
Fax
(314) 735-4335
NPI assigned
Oct 8, 2012
Last updated
Oct 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tysyn Contreras
Title
Director of Quality Assurance
Phone
(773) 751-7200

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X

Addresses

Primary practice location

10016 Office Center Ave
Suite 100
Saint Louis, MO 63128-1468

Mailing address

3319 N Elston Ave
Suite 200
Chicago, IL 60618-5811
Phone (773) 751-7200

Other names 1

  • Mobile Doctors of St. Louis Doing business as

National Provider Directory

National Provider Directory

Locations

3319 N Elston Ave
#100
Chicago, IL 60618
Phone (773) 751-7200

15800 W McNichols Rd
Ste 218L
Detroit, MI 48235
Phone (313) 272-9420

2335 S Linden Rd
Ste B
Flint, MI 48532
Phone (810) 620-8363

24567 Northwestern Hwy
Ste 150
Southfield, MI 48075
Phone (248) 207-9299

24567 Northwestern Hwy
Ste 440
Southfield, MI 48075
Phone (313) 272-9420

3201 Cherry Ridge Dr
#C315
San Antonio, TX 78230
Phone (210) 319-5487

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1992057566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 N ELSTON AVE",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185811",
            "telephone_number": "773-751-7200",
            "fax_number": "773-583-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10016 OFFICE CENTER AVE",
            "address_2": "SUITE 100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631281468",
            "telephone_number": "314-720-0855",
            "fax_number": "314-735-4335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MI MOBILE DOCTORS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "TYSYN",
        "authorized_official_title_or_position": "DIRECTOR OF QUALITY ASSURANCE",
        "authorized_official_telephone_number": "773-751-7200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Doctors of St. Louis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.