Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2008-10-10
- Last updated
- 2023-09-13
Specialties
Licenses
- License MO
- 2012020077
Location
- Practice location
- 701 S NEW BALLAS RD STE 310
- City
- SAINT LOUIS MO
- Postal code
- 631418725
- Phone
- 314-251-8750
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.