MEDICARE: ROJANASATHIT,M.D.P.C.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35075	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	177904	OTHER	MO	BLUE SHIELD

General Provider Information

NPI Number	:	1538289343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROJANASATHIT,M.D.P.C.

Provider Business Mailing Address
First Line	:	11155 DUNN RD STE 201E
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6149
Country	:	US
Telephone Number	:	314-355-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	11155 DUNN RD STE 201E
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6149
Country	:	US
Telephone Number	:	314-355-3175
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL SECRETARY
Name	:	MRS. JOYCE A HOLMES
Credential	:
Telephone Number	:	314-355-3175

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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