MEDICARE: ALEX H AMANAT 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	207P00000X	Emergency Medicine Physician	35661	MO

General Provider Information

NPI Number	:	1306846027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX H AMANAT MD

Provider Business Mailing Address
First Line	:	11903 SAINT CHARLES ROCK RD
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2623
Country	:	US
Telephone Number	:	314-770-0900
Fax Number	:	314-739-8569

Provider Business Practice Location Address
First Line	:	5422 SOUTHFIELD CTR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-5907
Country	:	US
Telephone Number	:	314-842-0707
Fax Number	:	314-842-0730

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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