Healthcare Provider Details

I. General information

NPI: 1962030874
Provider Name (Legal Business Name): ALEXANDER HUA-MING MARELICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

4643 LINDELL BLVD APT 309
SAINT LOUIS MO
63108-3727
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-7133
  • Fax: 314-577-8516
Mailing address:
  • Phone: 530-902-6579
  • Fax:

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 Number2020015736
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: