Healthcare Provider Details

I. General information

NPI: 1821256843
Provider Name (Legal Business Name): PEDIATRIC UROLOGY SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD ROOM 3709
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-4154
  • Fax:
Mailing address:
  • Phone: 314-989-0300
  • Fax: 314-810-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2003025342
License Number StateMO

VIII. Authorized Official

Name: DR. CASIMIR FIRLIT
Title or Position: OWNER/MANAGING EMPLOYEE
Credential: MD
Phone: 314-268-4154