Healthcare Provider Details

I. General information

NPI: 1144244930
Provider Name (Legal Business Name): ADRIAN M. DI BISCEGLIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 LAFAYETTE AVE
SAINT LOUIS MO
63104-1314
US

IV. Provider business mailing address

1008 S SPRING AVE FL 2
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-9400
  • Fax:
Mailing address:
  • Phone: 314-977-2140
  • Fax: 314-977-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number105308
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: