Healthcare Provider Details

I. General information

NPI: 1831425677
Provider Name (Legal Business Name): PLASTIC SURGERY INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 N MASON RD SUITE 100
SAINT LOUIS MO
63141-6338
US

IV. Provider business mailing address

969 N MASON RD SUITE 100
SAINT LOUIS MO
63141-6338
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-2278
  • Fax: 314-878-2311
Mailing address:
  • Phone: 314-878-2278
  • Fax: 314-878-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number116731
License Number StateMO

VIII. Authorized Official

Name: DR. HELEN TADJALLI
Title or Position: OWNER
Credential: M.D.
Phone: 314-878-2278