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General NPI Number Information
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NPI Number | 1831425677
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY INTERNATIONAL LLC
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 969 N MASON RD SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6338
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Country | US
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Telephone | 314-878-2278
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Fax | 314-878-2311
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Provider Business Mailing Address
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Address Line | 969 N MASON RD SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6338
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Country | US
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Telephone | 314-878-2278
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Fax | 314-878-2311
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Authorized Official
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Title or Position | OWNER
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Name | DR. HELEN TADJALLI
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Credential | M.D.
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Telephone | 314-878-2278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 116731
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License Number State | MO
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