| Missouri Endocrine & Diabetes Center, Inc. | |
|
12401 Olive Blvd Suite 207 Saint Louis MO 63141-5448 | |
| (636) 878-5530 | |
| (314) 878-2434 |
| Full Name | Missouri Endocrine & Diabetes Center, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 12401 Olive Blvd, Saint Louis, Missouri |
| Authorized Official Name and Position | Amin Radparvar (OWNER) |
| Authorized Official Contact | 6369399004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Missouri Endocrine & Diabetes Center, Inc. 12401 Olive Blvd Suite 207 Saint Louis MO 63141-5448 Ph: (636) 878-5530 | Missouri Endocrine & Diabetes Center, Inc. 12401 Olive Blvd Suite 207 Saint Louis MO 63141-5448 Ph: (636) 878-5530 |
| NPI Number | 1487895074 |
|---|---|
| Provider Enumeration Date | 03/12/2009 |
| Last Update Date | 10/30/2014 |
| Medicare PECOS PAC ID | 6204961345 |
|---|---|
| Medicare Enrollment ID | O20100315000954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487895074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | MDR1G71 (Missouri) | Primary |
| Provider Name | Amin Radparvar |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1316987837 PECOS PAC ID: 1850426990 Enrollment ID: I20100315000950 |
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