Healthcare Provider Details

I. General information

NPI: 1316679632
Provider Name (Legal Business Name): SUSAN MORAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL MSC 8116-0043-14
SAINT LOUIS MO
63110-1081
US

IV. Provider business mailing address

1 CHILDRENS PL MSC 8116-0043-14
SAINT LOUIS MO
63110-1081
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2094
  • Fax: 314-454-2515
Mailing address:
  • Phone: 314-454-2094
  • Fax: 314-454-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023044628
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: