Healthcare Provider Details

I. General information

NPI: 1063641223
Provider Name (Legal Business Name): JOSIE VITALE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSIE VITALE LORBERT

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 LANDMARK PARKWAY DR SUITE 207
SAINT LOUIS MO
63127-1665
US

IV. Provider business mailing address

9701 LANDMARK PARKWAY DR SUITE 207
SAINT LOUIS MO
63127-1665
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-8700
  • Fax: 314-849-8737
Mailing address:
  • Phone: 314-849-8700
  • Fax: 314-849-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009014225
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number2012013478
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: