Basic Information
| Provider Information | |||||||||
| NPI: | 1376960898 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME DOCTORS MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8147 DELMAR BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631303735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147219999 | ||||||||
| FaxNumber: | 3147213725 | ||||||||
| Practice Location | |||||||||
| Address1: | 8147 DELMAR BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631303735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147219999 | ||||||||
| FaxNumber: | 3147213725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2014 | ||||||||
| LastUpdateDate: | 11/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHENDEROV | ||||||||
| AuthorizedOfficialFirstName: | KARINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3145790087 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.