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General NPI Number Information
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NPI Number | 1205977857
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Entity Type | Organization
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Legal Business Name | AESTHETIC MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 3920 LINDELL BLVD STE 105
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3254
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Country | US
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Telephone | 314-652-8923
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Fax | 314-652-8925
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Provider Business Mailing Address
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Address Line | 3920 LINDELL BLVD STE 105
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3254
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Country | US
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Telephone | 314-652-8923
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Fax | 314-652-8925
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELISSA L HOLLIE
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Credential | MD
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Telephone | 314-652-8923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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