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NPI Code Detail

MEDICARE: DR. ANDREW MICAH GRABOWSKI DO

MEDICARE: DR. ANDREW MICAH GRABOWSKI DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2003019557MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1924975688OTHERMOMEDICARE PTAN #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093714917
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW MICAH GRABOWSKI DO
Provider Business Mailing Address
First Line : 4438 TELEGRAPH RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-3316
Country : US
Telephone Number : 314-543-5996
Fax Number : 314-543-5958
Provider Business Practice Location Address
First Line : 4438 TELEGRAPH RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-3316
Country : US
Telephone Number : 314-543-5996
Fax Number : 314-543-5958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 03/14/2017

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