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General NPI Number Information
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NPI Number | 1902126097
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Entity Type | Individual
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Provider Name | ROD EVAN PELLENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 11365 DORSETT RD.
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043
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Country | US
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Telephone | 314-872-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 11365 DORSETT ROAD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043
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Country | US
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Telephone | 314-872-6400
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 2017013705
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License Number State | MO
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