MEDICARE: AMARA PROFESSIONAL CORPORATION

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	207R00000X	Internal Medicine Physician	036-058285	IL
2	207R00000X	Internal Medicine Physician	35725	MO

General Provider Information

NPI Number	:	1255747267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMARA PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5615 PERSHING AVE
Second Line	:	SUITE 26
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1757
Country	:	US
Telephone Number	:	314-361-0477
Fax Number	:	314-361-3771

Provider Business Practice Location Address
First Line	:	5615 PERSHING AVE
Second Line	:	SUITE 26
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1757
Country	:	US
Telephone Number	:	314-361-0477
Fax Number	:	314-361-3771

Authorized Official
Title or Position	:	OWNER
Name	:	L. C. TUNSTALL-ROBINSON
Credential	:	M.D.
Telephone Number	:	314-361-0477

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	07/17/2014

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Directions to “AMARA PROFESSIONAL CORPORATION ” Practice Location

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