Healthcare Provider Details

I. General information

NPI: 1205816790
Provider Name (Legal Business Name): K. GEORGE THAMPY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: K. GEORGE THAMPY M.D.

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD SUITE 160B
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

10004 KENNERLY RD SUITE 160B
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-1588
  • Fax: 314-543-5298
Mailing address:
  • Phone: 314-842-1588
  • Fax: 314-543-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number112762
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: