Healthcare Provider Details

I. General information

NPI: 1912196833
Provider Name (Legal Business Name): FOOT SPECIALTY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 TELEGRAPH RD
SAINT LOUIS MO
63129-3555
US

IV. Provider business mailing address

5427 TELEGRAPH RD
SAINT LOUIS MO
63129-3555
US

V. Phone/Fax

Practice location:
  • Phone: 314-845-0200
  • Fax: 314-845-3223
Mailing address:
  • Phone: 314-845-0200
  • Fax: 314-845-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000714
License Number StateMO

VIII. Authorized Official

Name: DR. TERRANCE J MUELLER
Title or Position: PRACTICE OWNER
Credential: DPM
Phone: 314-845-0200