Healthcare Provider Details

I. General information

NPI: 1255388906
Provider Name (Legal Business Name): GRANT VINCENT BOCHICCHIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2611
  • Fax: 314-362-5743
Mailing address:
  • Phone: 314-273-0500
  • Fax: 314-273-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number2011020910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: