Healthcare Provider Details

I. General information

NPI: 1184839136
Provider Name (Legal Business Name): BAHM FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 NETHERTON DR STE 200
SAINT LOUIS MO
63136-4697
US

IV. Provider business mailing address

PO BOX 4204
CHESTERFIELD MO
63006-4204
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-5300
  • Fax: 314-521-4656
Mailing address:
  • Phone: 314-355-5300
  • Fax: 314-521-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109044
License Number StateMO

VIII. Authorized Official

Name: DR. AKINRINOLA FATOKI
Title or Position: MEMBER
Credential: MD
Phone: 314-355-5300