MEDICARE: IRINI E VERONIKIS 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD114336	MO

General Provider Information

NPI Number	:	1578508701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINI E VERONIKIS M.D.

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD STE 3006B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8282
Country	:	US
Telephone Number	:	314-251-6020
Fax Number	:	314-251-5952

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD STE 3006B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8282
Country	:	US
Telephone Number	:	314-251-6020
Fax Number	:	314-251-5952

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	01/07/2010

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