Healthcare Provider Details

I. General information

NPI: 1912436015
Provider Name (Legal Business Name): ROBERT ARA PETROSSIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

IV. Provider business mailing address

2307 S 9TH ST
SAINT LOUIS MO
63104-4220
US

V. Phone/Fax

Practice location:
  • Phone: 573-348-8000
  • Fax:
Mailing address:
  • Phone: 818-445-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA178626
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD497569
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2023045072
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036-167643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: