Healthcare Provider Details

I. General information

NPI: 1336766492
Provider Name (Legal Business Name): STLFERTILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N NEW BALLAS RD STE 150
SAINT LOUIS MO
63141-6843
US

IV. Provider business mailing address

555 N NEW BALLAS RD STE 150
SAINT LOUIS MO
63141-6843
US

V. Phone/Fax

Practice location:
  • Phone: 314-983-9000
  • Fax:
Mailing address:
  • Phone: 314-983-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOLINA DAYAL
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 314-983-9000