Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | Q8195 | TX |
Y | 208000000X | Pediatrician | 2018005742 | MO |
NPI | 1497190854 |
---|---|
Provider Name | Michel John Adonis |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2013 |
Last Update Date | 07/09/2018 |