Healthcare Provider Details

I. General information

NPI: 1184803579
Provider Name (Legal Business Name): KNIGHT INTERNISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 BELLEVUE AVE SUITE 205
ST. LOUIS MO
63117-1844
US

IV. Provider business mailing address

1035 BELLEVUE AVE SUITE 205
ST. LOUIS MO
63117-1844
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-3400
  • Fax: 314-645-3344
Mailing address:
  • Phone: 314-645-3400
  • Fax: 314-645-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26712
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number26712
License Number StateMO

VIII. Authorized Official

Name: MRS. VIVIAN LORRAINE MCCREE
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-645-3400