Healthcare Provider Details

I. General information

NPI: 1356674246
Provider Name (Legal Business Name): MUSTAFA ERKAN ALTINYAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD ST LOUIS UNIV SCH OF MED NUCLEAR MED PGM
SAINT LOUIS MO
63104
US

IV. Provider business mailing address

4475 W PINE BLVD APT 1701
SAINT LOUIS MO
63108-2326
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-8163
  • Fax: 314-268-5144
Mailing address:
  • Phone: 314-495-7326
  • 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: