Provider Demographics
NPI:1487898615
Name:LAWRENCE B. IKEN,DPM,LLC
Entity type:Organization
Organization Name:LAWRENCE B. IKEN,DPM,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:IKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-227-6477
Mailing Address - Street 1:14615 MANCHESTER ROAD
Mailing Address - Street 2:101
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:636-227-6477
Mailing Address - Fax:636-227-8168
Practice Address - Street 1:14615 MANCHESTER RD
Practice Address - Street 2:101
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-3790
Practice Address - Country:US
Practice Address - Phone:636-227-6477
Practice Address - Fax:636-227-8168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO360213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42860Medicare UPIN