Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake St Louis Dermatology PC

Organization Dermatology Physician · NPI 1255583746

Lake St Louis Dermatology PC is a Dermatology Physician in Lake St Louis, Missouri. Licensed in Missouri. Registered with an NPI since 2008.

Licensed in
MO
In the registry since
2008
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

300 Medical Plz Mob 2 Ste 210
Lake St Louis, MO 63367-1481
Phone: (636) 561-0026
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence MO2002031471 (MO)

Record details

NPI number1255583746
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Maria Canizares-Heyde — Dermatologist · (636) 561-0026
NPI enumeratedOctober 16, 2008
Last updated in NPPESFebruary 11, 2009
Mailing address300 Medical Plz, Mob 2, Suite 210, Lake St Louis, MO 63367-1481

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