| Dr. M. K. Onifade Internal Medicine Practice Llc | |
|
2880 Netherton Dr Ste 200 Saint Louis MO 63136-4697 | |
| (314) 355-5300 | |
| (314) 521-4656 |
| Full Name | Dr. M. K. Onifade Internal Medicine Practice Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2880 Netherton Dr Ste 200, Saint Louis, Missouri |
| Authorized Official Name and Position | Moyosore Kikelomo Onifade (MANAGER) |
| Authorized Official Contact | 3143555300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. M. K. Onifade Internal Medicine Practice Llc 2880 Netherton Dr Ste 200 Saint Louis MO 63136-4697 Ph: (314) 355-5300 | Dr. M. K. Onifade Internal Medicine Practice Llc 2880 Netherton Dr Ste 200 Saint Louis MO 63136-4697 Ph: (314) 355-5300 |
| NPI Number | 1932315942 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 10/21/2024 |
| Medicare PECOS PAC ID | 6305808353 |
|---|---|
| Medicare Enrollment ID | O20041102000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932315942 | NPI | - | NPPES |
| 208818716 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2002019255 (Missouri) | Primary |
| Provider Name | Moyosore K Onifade |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669586954 PECOS PAC ID: 5193628881 Enrollment ID: I20041108001081 |
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