Healthcare Provider Details

I. General information

NPI: 1467871137
Provider Name (Legal Business Name): THERESA DRALLMEIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLLY HILLS AVE
SAINT LOUIS MO
63111
US

IV. Provider business mailing address

1132 DUNWOODY DR
SAINT LOUIS MO
63122-1716
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-5190
  • Fax: 314-353-7631
Mailing address:
  • Phone: 573-465-0251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017019165
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: