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General NPI Number Information
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NPI Number | 1639497290
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Entity Type | Organization
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Legal Business Name | JOSEPH A. MUCCINI M.D. LLC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 222 S WOODS MILL RD SUITE 475
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3625
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Country | US
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Telephone | 314-878-0600
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Fax | 314-878-0602
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Provider Business Mailing Address
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Address Line | 222 S WOODS MILL RD SUITE 475
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3625
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Country | US
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Telephone | 314-878-0600
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Fax | 314-878-0602
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH ANTHONY MUCCINI II
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Credential | M.D.
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Telephone | 314-878-0600
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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 | 111874
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License Number State | MO
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