Provider Demographics
NPI:1801411871
Name:CANTAVE, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CANTAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 FOREST PARK AVENUE
Mailing Address - Street 2:SUITE 8064-37-905
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2317
Mailing Address - Country:US
Mailing Address - Phone:314-362-1016
Mailing Address - Fax:314-747-1490
Practice Address - Street 1:4901 FOREST PARK AVENUE
Practice Address - Street 2:SUITE 8064-37-905
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-362-1016
Practice Address - Fax:314-747-1490
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020016131207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology