MEDICARE: TAMARA SANTARELLI

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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1750522439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA SANTARELLI

Provider Business Mailing Address
First Line	:	425 E LOCUST ST
Second Line	:
City	:	COLUMBIA
State	:	IL
Zip	:	62236-2092
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S ELM AVE
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3845
Country	:	US
Telephone Number	:	314-962-3464
Fax Number	:

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/10/2009

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Directions to “ TAMARA SANTARELLI ” Practice Location

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