MEDICARE: CHILDRENS ENDOCRINE CARE OF ST. LOUIS, LLC

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	2080P0205X	Pediatric Endocrinology Physician

General Provider Information

NPI Number	:	1114114691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS ENDOCRINE CARE OF ST. LOUIS, LLC

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD
Second Line	:	SUITE 3002 B
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-3002
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD
Second Line	:	SUITE 3002 B
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-8232
Country	:	US
Telephone Number	:	314-251-3002
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. MYRTO FRANGOS
Credential	:
Telephone Number	:	314-251-3002

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	09/28/2007

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