Healthcare Provider Details

I. General information

NPI: 1073388468
Provider Name (Legal Business Name): GUNDA ZVIGULE-NEIDERE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WUSM PEDS, 1 CHILDRENS PL MSC 8208-0016-01
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

WUSM PEDS, 1 CHILDRENS PL MSC 8208-0016-01
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2527
  • Fax: 314-747-8880
Mailing address:
  • Phone: 314-454-2527
  • Fax: 314-747-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023020369
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: