Provider Demographics
NPI:1790739241
Name:CANNISTRARO, ROSEMARY LOUISE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:LOUISE
Last Name:CANNISTRARO
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Gender:F
Credentials:MD PHD
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Mailing Address - Street 1:11550 OLIVE BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7111
Mailing Address - Country:US
Mailing Address - Phone:314-205-8344
Mailing Address - Fax:314-590-5931
Practice Address - Street 1:11550 OLIVE BLVD
Practice Address - Street 2:STE 140
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7111
Practice Address - Country:US
Practice Address - Phone:314-205-8344
Practice Address - Fax:314-590-5931
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-10-27
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Provider Licenses
StateLicense IDTaxonomies
MO100907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00257143OtherRR MEDICARE
MO947494725Medicare PIN
MOG14745Medicare UPIN