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Organization
SSM DEPAUL MEDICAL GROUP
Active
Organization
SSM DEPAUL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA PULLUM (DIRECTOR)
(636) 669-2434
Entity
Organization
Contact information
Practice address
1551 WALL ST, SUITE 400, SAINT CHARLES, MO 63303-3539
(636) 669-2420
(636) 669-2401
Mailing address
1551 WALL ST, SUITE 310, SAINT CHARLES, MO 63303-3539
(636) 669-2268
(314) 209-8127
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
—
—
213E00000X
Podiatrist
Primary
2004019662
MO
Other
Enumeration date
10/17/2013
Last updated
10/17/2013
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