Provider Demographics
NPI:1174699193
Name:ENDOCRINOLOGY DIABETES & METABOLISM CONSULTANTS P C
Entity type:Organization
Organization Name:ENDOCRINOLOGY DIABETES & METABOLISM CONSULTANTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:THAMPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-842-1588
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 160B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-842-1588
Mailing Address - Fax:314-543-5298
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 160B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-842-1588
Practice Address - Fax:314-543-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112762207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty