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NPI Code Detail

MEDICARE: DR. TARA MARIE BUDETTI M.D.

MEDICARE: DR. TARA MARIE BUDETTI 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
1208000000XPediatrics Physician2008016533MO

General Provider Information

NPI Number : 1285811059
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARA MARIE BUDETTI M.D.
Provider Business Mailing Address
First Line : 4352 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2138
Country : US
Telephone Number : 314-531-5444
Fax Number : 314-531-0063
Provider Business Practice Location Address
First Line : 4352 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2138
Country : US
Telephone Number : 314-531-5444
Fax Number : 314-531-0063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2008
Last Update Date : 07/18/2024

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