Healthcare Provider Details

I. General information

NPI: 1124458013
Provider Name (Legal Business Name): DMMMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 CLAYTON RD SUITE 100
SAINT LOUIS MO
63124-1685
US

IV. Provider business mailing address

9890 CLAYTON RD SUITE 100
SAINT LOUIS MO
63124-1685
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-1515
  • Fax:
Mailing address:
  • Phone: 314-725-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number110678
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID MICHAEL MONTANI
Title or Position: OWNER
Credential: M.D.
Phone: 618-334-5256