Healthcare Provider Details

I. General information

NPI: 1396826152
Provider Name (Legal Business Name): ST LOUIS MEDICAL PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 WATSON RD SUITE 201
SAINT LOUIS MO
63119-5140
US

IV. Provider business mailing address

8790 WATSON RD SUITE 201
SAINT LOUIS MO
63119-5140
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-2800
  • Fax: 314-543-2801
Mailing address:
  • Phone: 314-543-2800
  • Fax: 314-543-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NEEVEEN SALAMA
Title or Position: BILLING
Credential:
Phone: 314-543-2800