Healthcare Provider Details

I. General information

NPI: 1528186863
Provider Name (Legal Business Name): ST. LOUIS CHILD NEUROLOGY SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD 5009B
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD 5009B
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-5866
  • Fax: 314-251-5867
Mailing address:
  • Phone: 314-251-5866
  • Fax: 314-251-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENIS IAN ALTMAN
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 314-251-5866