| Vitae Health Medical Missouri Llc | |
|
3625 Magnolia Ave Saint Louis MO 63110-4048 | |
| (314) 771-2990 | |
| Not Available |
| Full Name | Vitae Health Medical Missouri Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3625 Magnolia Ave, Saint Louis, Missouri |
| Authorized Official Name and Position | Amish Patel (PRESIDENT) |
| Authorized Official Contact | 8338482347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitae Health Medical Missouri Llc 415 W Golf Rd Ste 26 Arlington Heights IL 60005-3923 Ph: (224) 777-8034 | Vitae Health Medical Missouri Llc 3625 Magnolia Ave Saint Louis MO 63110-4048 Ph: (314) 771-2990 |
| NPI Number | 1720726748 |
|---|---|
| Provider Enumeration Date | 05/20/2022 |
| Last Update Date | 05/24/2022 |
| Certification Date | 05/24/2022 |
| Medicare PECOS PAC ID | 5698155984 |
|---|---|
| Medicare Enrollment ID | O20220705000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720726748 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Zahra Shariff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538260492 PECOS PAC ID: 8527084128 Enrollment ID: I20051024000016 |
| Provider Name | David Woodard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760504013 PECOS PAC ID: 5991185225 Enrollment ID: I20220705002145 |
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