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General NPI Number Information
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NPI Number | 1992721047
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Entity Type | Organization
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Legal Business Name | MIDWEST MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 4346 LOUGHBOROUGH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63116-2104
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Country | US
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Telephone | 314-481-7030
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Fax | 314-481-7120
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Provider Business Mailing Address
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Address Line | 4346 LOUGHBOROUGH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63116-2104
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Country | US
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Telephone | 314-481-7030
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Fax | 314-481-7120
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. ALEXANDER RUDOI
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Credential | MD
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Telephone | 314-481-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MO100186
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License Number State | MO
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