MEDICARE: DR. ENGIN TAYSI M.D.

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	2084P0800X	Psychiatry Physician	36213	MO

General Provider Information

NPI Number	:	1689673451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENGIN TAYSI M.D.

Provider Business Mailing Address
First Line	:	5000 CEDAR PLAZA PARKWAY
Second Line	:	STE 350
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3441
Country	:	US
Telephone Number	:	314-843-4333
Fax Number	:	314-843-4856

Provider Business Practice Location Address
First Line	:	12255 DE PAUL DR
Second Line	:	SUITE 250
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2510
Country	:	US
Telephone Number	:	314-344-7770
Fax Number	:	314-344-7774

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/13/2012

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