Healthcare Provider Details

I. General information

NPI: 1811154206
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD MERCY DOCTORS BLDG TOWER B SUITE 5003
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

140 JUNGERMANN RD
SAINT PETERS MO
63376-1698
US

V. Phone/Fax

Practice location:
  • Phone: 636-527-7278
  • Fax: 636-527-7201
Mailing address:
  • Phone: 636-928-0078
  • Fax: 636-928-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GRAEME MINDEL
Title or Position: OWNER
Credential: MD
Phone: 636-928-0078