Basic Information
Provider Information
NPI: 1871556332
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LENZENHUBER
FirstName: KARL
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 555 N NEW BALLAS RD
Address2: SUITE 150
City: SAINT LOUIS
State: MO
PostalCode: 631416825
CountryCode: US
TelephoneNumber: 3149918200
FaxNumber: 3149918206
Practice Location
Address1: 901 E 5TH ST
Address2:  
City: WASHINGTON
State: MO
PostalCode: 630903127
CountryCode: US
TelephoneNumber: 6362398250
FaxNumber: 3149918206
Other Information
ProviderEnumerationDate: 04/07/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XR2B39MOY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


Home