| Daniel Gaitan Healthcare, Inc | |
|
425 N New Ballas Rd Ste 107 Saint Louis MO 63141-6845 | |
| (314) 432-2592 | |
| (314) 432-2595 |
| Full Name | Daniel Gaitan Healthcare, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 425 N New Ballas Rd Ste 107, Saint Louis, Missouri |
| Authorized Official Name and Position | Daniel Gaitan (OWNER) |
| Authorized Official Contact | 3144981977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daniel Gaitan Healthcare, Inc 425 N New Ballas Rd Ste 107 Saint Louis MO 63141-6845 Ph: (314) 432-2592 | Daniel Gaitan Healthcare, Inc 425 N New Ballas Rd Ste 107 Saint Louis MO 63141-6845 Ph: (314) 432-2592 |
| NPI Number | 1407487457 |
|---|---|
| Provider Enumeration Date | 01/29/2020 |
| Last Update Date | 03/01/2021 |
| Medicare PECOS PAC ID | 4082042320 |
|---|---|
| Medicare Enrollment ID | O20200319001001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407487457 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Daniel Gaitan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598865636 PECOS PAC ID: 7416084819 Enrollment ID: I20100723000950 |
| Provider Name | Melissa Colleen Frazier-gaitan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760149082 PECOS PAC ID: 8224422894 Enrollment ID: I20220224000529 |
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