Organization · Type 2 NPI

Healthcare Medicare

Adult Medicine Physician · St. Louis, MO

NPI number 1649869678 Active

Practice location

7700 Forsyth Blvd
St. Louis, MO 63105-1810

Specialties and licenses

TaxonomyCodeLicense
Adult Medicine Physician Primary 207QA0505XNone listed

Adult Medicine Physician: The NUCC recommends this code not be used. Choose a more appropriate code.

21 other providers at this address

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About NPI 1649869678

Healthcare Medicare's National Provider Identifier is 1649869678, issued on Jan 14, 2021. The primary taxonomy on file is Adult Medicine Physician (207QA0505X), and the practice location is in St. Louis, MO. The record was last updated on Oct 16, 2026.