Healthcare Provider Details

I. General information

NPI: 1629047626
Provider Name (Legal Business Name): DIONYSIOS K VERONIKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 2002 TOWER B
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD SUITE 2002 TOWER B
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6753
  • Fax: 314-251-4492
Mailing address:
  • Phone: 314-251-6753
  • Fax: 314-251-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number112659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: