MEDICARE: ANDREW TANOUS

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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	2023032402	MO

General Provider Information

NPI Number	:	1508549361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW TANOUS

Provider Business Mailing Address
First Line	:	16350 LYDIA HILL DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-7835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 S NEW BALLAS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8702
Country	:	US
Telephone Number	:	314-251-6712
Fax Number	:

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

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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