Provider Demographics
NPI:1578508701
Name:VERONIKIS, IRINI E (MD)
Entity Type:Individual
Prefix:
First Name:IRINI
Middle Name:E
Last Name:VERONIKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 3006B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8282
Mailing Address - Country:US
Mailing Address - Phone:314-251-6020
Mailing Address - Fax:314-251-5952
Practice Address - Street 1:621 S NEW BALLAS RD STE 3006B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8282
Practice Address - Country:US
Practice Address - Phone:314-251-6020
Practice Address - Fax:314-251-5952
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD114336207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG06916Medicare UPIN
MO7417Medicare ID - Type Unspecified