Healthcare Provider Details

I. General information

NPI: 1093379653
Provider Name (Legal Business Name): LOLITA GOLEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

600 S PAULINA ST
CHICAGO IL
60612-3806
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8000
  • Fax:
Mailing address:
  • Phone: 773-396-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: