Basic Information
| Provider Information | |||||||||
| NPI: | 1902111826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC INTERNISTS OF CHESTERFIELD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 S WOODS MILL RD | ||||||||
| Address2: | STE 410 | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148787220 | ||||||||
| FaxNumber: | 3148780047 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 SAINT LUKES CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145762490 | ||||||||
| FaxNumber: | 3145762433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2010 | ||||||||
| LastUpdateDate: | 08/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | SONNE | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3145762490 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. LUKE'S MEDICAL GROUP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.