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General NPI Number Information
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NPI Number | 1053117598
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Entity Type | Organization
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Legal Business Name | CROSSROADS CLINIC VOLUNTEERS IN MEDICINE
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 10890 VETERANS MEMORIAL PARKWAY
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City | LAKE ST. LOUIS
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State | MO
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Zip | 63367
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Country | US
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Telephone | 636-561-3133
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Fax | 636-625-3534
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Provider Business Mailing Address
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Address Line | 10890 VETERANS MEMORIAL PARKWAY
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City | LAKE ST. LOUIS
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State | MO
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Zip | 63367
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Country | US
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Telephone | 636-561-3133
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Fax | 636-625-3534
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MAIMUNA BAIG
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Credential | M.D.
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Telephone | 636-561-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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