Healthcare Provider Details

I. General information

NPI: 1134358153
Provider Name (Legal Business Name): EMILY FITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2009
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE DEPARTMENT OF EMERGENCY MEDICINE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

4100 FOREST PARK AVE #222
SAINT LOUIS MO
63108-2885
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-7133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2009017028
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: