Provider Demographics
NPI:1215563374
Name:RAFI FREDMAN MD LLC
Entity Type:Organization
Organization Name:RAFI FREDMAN MD LLC
Other - Org Name:AMELIA AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFI
Authorized Official - Middle Name:SHMUEL
Authorized Official - Last Name:FREDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-277-3715
Mailing Address - Street 1:1551 WALL ST STE 420
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3541
Mailing Address - Country:US
Mailing Address - Phone:636-329-4036
Mailing Address - Fax:636-206-2898
Practice Address - Street 1:1551 WALL ST STE 420
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3541
Practice Address - Country:US
Practice Address - Phone:636-329-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center