Healthcare Provider Details

I. General information

NPI: 1205255379
Provider Name (Legal Business Name): MANOJ PARIMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 198A
SAINT LOUIS MO
63141-8255
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 198A
SAINT LOUIS MO
63141-8255
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6777
  • Fax:
Mailing address:
  • Phone: 314-251-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number2017011295
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: