Provider Demographics
NPI:1083697668
Name:ATZEMIS, ADRIENNE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:DENISE
Last Name:ATZEMIS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-2879
Mailing Address - Fax:314-454-2473
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED SAM CLINIC
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2879
Practice Address - Fax:314-454-2473
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010010432207PP0204X, 2080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204224505Medicaid