Healthcare Provider Details

I. General information

NPI: 1689072324
Provider Name (Legal Business Name): LADUE INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8857B LADUE RD
SAINT LOUIS MO
63124-2058
US

IV. Provider business mailing address

8857 LADUE RD STE B
SAINT LOUIS MO
63124-2045
US

V. Phone/Fax

Practice location:
  • Phone: 314-682-3626
  • Fax: 314-590-5954
Mailing address:
  • Phone: 314-682-3626
  • Fax: 314-590-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN R. HASKELL
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD.
Phone: 314-205-6444