Healthcare Provider Details

I. General information

NPI: 1932947017
Provider Name (Legal Business Name): GYNECOLOGIC ONCOLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 370A
SAINT LOUIS MO
63128-5118
US

IV. Provider business mailing address

44 CHESTERFIELD LAKES RD
CHESTERFIELD MO
63005-4506
US

V. Phone/Fax

Practice location:
  • Phone: 314-928-0928
  • Fax: 888-440-2472
Mailing address:
  • Phone: 203-508-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN-ARIN SILASI
Title or Position: MD
Credential: MD
Phone: 203-508-3311