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General NPI Number Information
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NPI Number | 1073069522
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Entity Type | Organization
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Legal Business Name | TADROS MEDICAL, LLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 9701 LANDMARK PARKWAY DR SUITE 110
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1665
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Country | US
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Telephone | 314-270-4247
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Fax | 314-270-4248
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Provider Business Mailing Address
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Address Line | 9701 LANDMARK PARKWAY DR SUITE 110
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1665
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Country | US
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Telephone | 314-270-4247
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Fax | 866-542-7823
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. CHARLES H TADROS
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Credential | M.D.
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Telephone | 314-270-4247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R7P58
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License Number State | MO
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