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General NPI Number Information
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NPI Number | 1558546515
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Entity Type | Individual
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Provider Name | AYOTUNDE MARK BAMIMORE M.D
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Gender | Male
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 400 1ST CAPITOL DR STE 401
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2886
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Country | US
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Telephone | 636-669-2220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 955534
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City | SAINT LOUIS
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State | MO
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Zip | 63195-2551
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Country | US
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Telephone |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2012-00809
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2013027460
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 2013027460
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License Number State | MO
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