MEDICARE: GEORGE EMANUEL MENDELSOHN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	R3359	MO

General Provider Information

NPI Number	:	1275801896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE EMANUEL MENDELSOHN M.D.

Provider Business Mailing Address
First Line	:	24 LOREN WOODS
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1903
Country	:	US
Telephone Number	:	314-991-0247
Fax Number	:	314-991-5567

Provider Business Practice Location Address
First Line	:	24 LOREN WOODS
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1903
Country	:	US
Telephone Number	:	314-991-0247
Fax Number	:	314-991-5567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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