Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2022-11-02
- Last updated
- 2022-11-02
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 9374 OLIVE BLVD STE 101
- City
- OLIVETTE MO
- Postal code
- 631323253
- Phone
- 314-932-2402
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.