Healthcare Provider Details

I. General information

NPI: 1306296447
Provider Name (Legal Business Name): DOCTORS ON THE GO1 L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N WARSON RD 249
OLIVETTE MO
63132-1111
US

IV. Provider business mailing address

1515 N WARSON RD 249
OLIVETTE MO
63132-1111
US

V. Phone/Fax

Practice location:
  • Phone: 314-925-7595
  • Fax:
Mailing address:
  • Phone: 314-925-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. DENIS MIKHLIN
Title or Position: OWNER
Credential:
Phone: 314-216-0838