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General NPI Number Information
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NPI Number | 1801831045
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Entity Type | Organization
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Legal Business Name | ST LOUIS CARDIOLOGY CONSULTANTS LTD
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 2 MEMORIAL DR STE 106
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City | ALTON
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State | IL
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Zip | 62002-6723
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Country | US
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Telephone | 618-433-1861
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Fax | 618-433-9274
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Provider Business Mailing Address
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Address Line | 2 MEMORIAL DR STE 106
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City | ALTON
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State | IL
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Zip | 62002-6723
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Country | US
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Telephone | 618-433-1861
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Fax | 618-433-9274
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Authorized Official
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Title or Position | MD
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Name | DR. SAMER THANAVARO
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Credential | MD
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Telephone | 618-433-1861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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