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General NPI Number Information
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NPI Number | 1831693381
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Entity Type | Organization
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Legal Business Name | WHOLE CHILD PEDIATRICS, LLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 522 N NEW BALLAS RD STE 245
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City | CREVE COEUR
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State | MO
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Zip | 63141-6854
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Country | US
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Telephone | 314-272-4005
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Fax | 314-442-7765
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Provider Business Mailing Address
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Address Line | 9788 GERALD DR
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City | SAINT LOUIS
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State | MO
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Zip | 63128-1708
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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 | MANAGING MEMBER
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Name | JOSEPH CANGAS
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Credential | MD
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Telephone | 314-435-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2006007755
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License Number State | MO
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