Healthcare Provider Details

I. General information

NPI: 1790974004
Provider Name (Legal Business Name): ALLERGY & ASTHMA CARE OF ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 WOODLAKE DR SUITE 201
CHESTERFIELD MO
63017-5740
US

IV. Provider business mailing address

1585 WOODLAKE DR SUITE 201
CHESTERFIELD MO
63017-5740
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-2788
  • Fax: 314-878-8988
Mailing address:
  • Phone: 314-878-2788
  • Fax: 314-878-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberR8C97
License Number StateMO

VIII. Authorized Official

Name: DR. MICHELE E KEMP
Title or Position: PRESIDENT
Credential: MD
Phone: 314-878-2788