Basic Information
| Provider Information | |||||||||
| NPI: | 1902105646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TATSUMI | ||||||||
| FirstName: | KANAYO | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 CLARK AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631032718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146224971 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1300 CLARK AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631032718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146224971 | ||||||||
| FaxNumber: | 3149777615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2011 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZF0201X | 278417 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | 207ZP0102X | 2019024496 | MO | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 278417 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207ZF0201X | 2019024496 | MO | Y | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology |
No ID Information.