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General NPI Number Information
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NPI Number | 1215103643
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Entity Type | Organization
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Legal Business Name | NEIL I. BRICKEL, MD, INC
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 11477 OLDE CABIN RD SUITE 210
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7130
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Country | US
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Telephone | 314-997-5208
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Fax | 314-997-5368
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Provider Business Mailing Address
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Address Line | 11477 OLDE CABIN RD SUITE 210
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7130
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Country | US
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Telephone | 314-997-5208
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Fax | 314-997-5368
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Authorized Official
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Title or Position | MANAGER
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Name | MS. MOLLY I KENNEDY
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Credential |
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Telephone | 314-997-5208
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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 | 31040
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License Number State | MO
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