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General NPI Number Information
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NPI Number | 1144089913
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Entity Type | Individual
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Provider Name | MAXWELL TODD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 1201 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1016
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Country | US
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Telephone | 314-257-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4567 W PINE BLVD APT 523
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2185
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Country | US
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Telephone | 217-273-9288
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Fax |
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 2025018819
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License Number State | MO
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