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General NPI Number Information
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NPI Number | 1841216702
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Entity Type | Individual
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Provider Name | MIGGIE L GREENBERG MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 1221 S GRAND
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City | ST LOUIS
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State | MO
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Zip | 63104
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Country | US
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Telephone | 314-577-8720
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Fax | 314-268-5494
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Provider Business Mailing Address
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Address Line | 3691 RUTGER AVE PROVIDER ENROLLMENT
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City | ST LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-977-4440
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2001010861
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License Number State | MO
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