Provider Demographics
NPI:1063641223
Name:VITALE, JOSIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSIE
Middle Name:
Last Name:VITALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:VITALE
Other - Last Name:LORBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9701 LANDMARK PARKWAY DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1665
Mailing Address - Country:US
Mailing Address - Phone:314-849-8700
Mailing Address - Fax:314-849-8737
Practice Address - Street 1:9701 LANDMARK PARKWAY DR
Practice Address - Street 2:SUITE 207
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1665
Practice Address - Country:US
Practice Address - Phone:314-849-8700
Practice Address - Fax:314-849-8737
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014225208000000X
MO2012013478207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics