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General NPI Number Information
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NPI Number | 1063555860
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Entity Type | Individual
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Provider Name | PHILLIP ERWIN KORENBLAT M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 1040 N MASON RD SUITE 112
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6399
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Country | US
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Telephone | 314-514-8509
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Fax | 314-542-0109
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Provider Business Mailing Address
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Address Line | 1040 N MASON RD SUITE 112
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6399
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Country | US
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Telephone | 314-514-8509
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Fax | 314-542-0109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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