Basic Information
| Provider Information | |||||||||
| NPI: | 1962521609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENTZELOPOULOS | ||||||||
| FirstName: | PARASKEVI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4910 W PINE BLVD | ||||||||
| Address2: | APT501 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631081976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036757695 | ||||||||
| FaxNumber: | 3143627641 | ||||||||
| Practice Location | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | CMPS BOX 8127 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143627617 | ||||||||
| FaxNumber: | 3143627641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 2005022500 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 2005022500 | 01 | MO | LICENSE NUMBER | OTHER | BM9407897 | 01 | MO | DEA NUMBER | OTHER |