MEDICARE: DR. CARLINE ST LOUIS MD

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
1	208000000X	Pediatrics Physician	ME74443	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1093799579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLINE ST LOUIS MD

Provider Business Mailing Address
First Line	:	5800 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3702
Country	:	US
Telephone Number	:	718-630-6180
Fax Number	:	718-630-7437

Provider Business Practice Location Address
First Line	:	3414 CHURCH AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203
Country	:	US
Telephone Number	:	718-630-2197
Fax Number	:	718-940-2914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	05/21/2013

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