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General NPI Number Information
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NPI Number | 1639141625
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Entity Type | Organization
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Legal Business Name | RENAL ALLIANCE, LLC
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD SUITE 315A
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2141
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Country | US
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Telephone | 314-843-3449
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Fax | 314-843-8762
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Provider Business Mailing Address
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Address Line | 1836 LACKLAND HILL PKWY
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3572
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Country | US
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Telephone | 314-989-0300
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Fax |
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Authorized Official
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Title or Position | OWNER OF PRACTICE
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Name | DR. KARTHIKAPALLIL ANTONY
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Credential | MD
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Telephone | 314-843-3449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 2001004843
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License Number State | MO
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