Healthcare Provider Details

I. General information

NPI: 1295312817
Provider Name (Legal Business Name): CHRISTOPHER PHELAN AHLERING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SOUTH GRAND BLVD.
SAINT LOUIS MO
63104
US

IV. Provider business mailing address

3691 RUTGER ST FL 1
SAINT LOUIS MO
63110-2515
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-1320
  • Fax: 314-977-1628
Mailing address:
  • Phone: 314-977-1919
  • Fax: 314-977-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2024016526
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: