MEDICARE: RODOLFO MACEREN MD

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	207L00000X	Anesthesiology Physician	R6445	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24219	OTHER	MO	CDS

General Provider Information

NPI Number	:	1447201868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODOLFO MACEREN MD

Provider Business Mailing Address
First Line	:	2 HOWE XING
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-4044
Country	:	US
Telephone Number	:	636-933-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	HWY 61S AT HWY 67
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019
Country	:	US
Telephone Number	:	636-933-1000
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/07/2023

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Directions to “ RODOLFO MACEREN MD” Practice Location

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