Healthcare Provider Details

I. General information

NPI: 1184727984
Provider Name (Legal Business Name): CHRISTINA M MANNIX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHRISTINA M ARMBRECHT

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5395
  • Fax: 314-268-6459
Mailing address:
  • Phone: 314-577-5395
  • Fax: 314-268-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036108876
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007027356
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2007027356
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: