Healthcare Provider Details

I. General information

NPI: 1114114691
Provider Name (Legal Business Name): CHILDRENS ENDOCRINE CARE OF ST. LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 3002 B
CREVE COEUR MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD SUITE 3002 B
CREVE COEUR MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-3002
  • Fax:
Mailing address:
  • Phone: 314-251-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MYRTO FRANGOS
Title or Position: MD
Credential:
Phone: 314-251-3002