Healthcare Provider Details

I. General information

NPI: 1700319878
Provider Name (Legal Business Name): MELANIE TRENKAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE SOWADSKI

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD RM 2717
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: 314-577-5634
  • Fax: 314-577-5616
Mailing address:
  • Phone: 314-577-5643
  • Fax: 314-268-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1700319878
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: