Provider Demographics
NPI:1790974004
Name:ALLERGY & ASTHMA CARE OF ST. LOUIS
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA CARE OF ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-878-2788
Mailing Address - Street 1:1585 WOODLAKE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5740
Mailing Address - Country:US
Mailing Address - Phone:314-878-2788
Mailing Address - Fax:314-878-8988
Practice Address - Street 1:1585 WOODLAKE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5740
Practice Address - Country:US
Practice Address - Phone:314-878-2788
Practice Address - Fax:314-878-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8C97207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10533Medicare UPIN
MOA78760Medicare UPIN
MO990000990Medicare PIN