Healthcare Provider Details

I. General information

NPI: 1578358131
Provider Name (Legal Business Name): EDDIE M KIRUMIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 OLIVE ST
SAINT LOUIS MO
63103-2360
US

IV. Provider business mailing address

7672 W BETTY ELYSE LN
PEORIA AZ
85382-3835
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-6840
  • Fax:
Mailing address:
  • Phone: 602-723-8823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: