Healthcare Provider Details

I. General information

NPI: 1578508701
Provider Name (Legal Business Name): IRINI E VERONIKIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 3006B
SAINT LOUIS MO
63141-8282
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 3006B
SAINT LOUIS MO
63141-8282
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6020
  • Fax: 314-251-5952
Mailing address:
  • Phone: 314-251-6020
  • Fax: 314-251-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD114336
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: