| NPI | 1467328336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALIE KREIGHBAUM Credentialing Specialist 314-909-1920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2025-10-16 |
| Last Update Date | 2025-10-16 |