Healthcare Provider Details

I. General information

NPI: 1275714743
Provider Name (Legal Business Name): ST LOUIS ALLERGY CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 368
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 368
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-7958
  • Fax: 314-872-7938
Mailing address:
  • Phone: 314-872-7958
  • Fax: 314-872-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ALLEN THIEL
Title or Position: PRESIDENT
Credential: MD
Phone: 314-872-7958