Healthcare Provider Details

I. General information

NPI: 1568378511
Provider Name (Legal Business Name): ADRIATIC DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4191 CRESCENT DR STE A
SAINT LOUIS MO
63129-1000
US

IV. Provider business mailing address

4191 CRESCENT DR STE A
SAINT LOUIS MO
63129-1000
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-2897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. SEJLA MAKSUMIC
Title or Position: OWNER
Credential: MAKSUMIC
Phone: 314-814-2897