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General NPI Number Information
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NPI Number | 1972633733
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Entity Type | Organization
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Legal Business Name | NEUROLOGICAL AND ELECTRODIAGNOSTIC INSTITUTE OF ST. LOUIS INC.
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 14825 N OUTER 40 SUITE 330
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2152
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Country | US
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Telephone | 636-537-0525
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Fax | 636-537-0575
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Provider Business Mailing Address
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Address Line | 14825 N OUTER 40 SUITE 330
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2152
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Country | US
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Telephone | 636-537-0525
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Fax | 636-537-0575
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. THERESA PULJIC
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Credential |
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Telephone | 636-537-0525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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