Healthcare Provider Details

I. General information

NPI: 1720726748
Provider Name (Legal Business Name): VITAE HEALTH MEDICAL MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 MAGNOLIA AVE
SAINT LOUIS MO
63110-4048
US

IV. Provider business mailing address

415 W GOLF RD STE 26
ARLINGTON HEIGHTS IL
60005-3923
US

V. Phone/Fax

Practice location:
  • Phone: 314-771-2990
  • Fax:
Mailing address:
  • Phone: 224-777-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YITZCHAK FREUND
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 224-777-8045