# M. EDWARD MIMLITZ PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952715005
- **Authorized official:** MR. MICHAEL E. MIMLITZ M.D. (PRESIDENT)
- **Authorized official phone:** (314) 432-8505

## Contact information

- **Practice address:** 621 S. NEW BALLAS RD., SUITE 419-A, ST. LOUIS, MO 63141-8259
- **Practice address phone:** (314) 432-8505
- **Practice address fax:** (314) 432-6853
- **Mailing address:** 621 S. NEW BALLAS RD., SUITE 419-A, ST. LOUIS, MO 63141-8259
- **Mailing address phone:** (314) 432-8505
- **Mailing address fax:** (314) 432-6853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 101836 | MO | Yes |

## Other

- **Enumeration date:** 06/17/2014
- **Last updated:** 07/02/2014