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NPI Code Detail

MEDICARE: MIKAEL GARRI MD

MEDICARE:   MIKAEL  GARRI  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
1207R00000XInternal Medicine Physician2012031776MO

General Provider Information

NPI Number : 1306076120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAEL GARRI MD
Provider Business Mailing Address
First Line : 621 S NEW BALLAS RD
Second Line : SUITE 3016B
City : CREVE COEUR
State : MO
Zip : 63141-8232
Country : US
Telephone Number : 314-251-6339
Fax Number : 314-251-4564
Provider Business Practice Location Address
First Line : 621 S NEW BALLAS RD
Second Line : SUITE 3016B
City : CREVE COEUR
State : MO
Zip : 63141-8232
Country : US
Telephone Number : 314-251-6339
Fax Number : 314-251-4564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2009
Last Update Date : 01/04/2017

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