Provider Demographics
NPI:1649627597
Name:ERMITANO, EMILY BACH (DPM)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:BACH
Last Name:ERMITANO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:F
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1224 GRAHAM RD STE 3010
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-355-0074
Mailing Address - Fax:314-355-0337
Practice Address - Street 1:1224 GRAHAM RD STE 3010
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-355-0074
Practice Address - Fax:314-355-0337
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
IL016.005852213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist