Healthcare Provider Details

I. General information

NPI: 1306027909
Provider Name (Legal Business Name): CHAD MICHAEL RONHOLM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2007
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S ELM AVE
SAINT LOUIS MO
63119-3845
US

IV. Provider business mailing address

520 S ELM AVE
SAINT LOUIS MO
63119-3845
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-4434
  • Fax: 314-645-3801
Mailing address:
  • Phone: 314-645-4434
  • Fax: 314-645-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2010026420
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2010026420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: