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General NPI Number Information
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NPI Number | 1306296447
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Entity Type | Organization
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Legal Business Name | DOCTORS ON THE GO1 L.C
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 1515 N WARSON RD 249
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City | OLIVETTE
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State | MO
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Zip | 63132-1111
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Country | US
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Telephone | 314-925-7595
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 N WARSON RD 249
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City | OLIVETTE
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State | MO
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Zip | 63132-1111
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Country | US
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Telephone | 314-925-7595
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DENIS MIKHLIN
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Credential |
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Telephone | 314-216-0838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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