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General NPI Number Information
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NPI Number | 1730384413
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Entity Type | Individual
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Provider Name | ANGELA M PASSANISE D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 801 MEDICAL DR STE 400
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City | WENTZVILLE
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State | MO
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Zip | 63385-3824
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Country | US
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Telephone | 636-332-8455
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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 | 63195-5534
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 34.010491
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 03478
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | DO178709
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | DO178709
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 2013018503
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License Number State | MO
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