Individual
TATYANA PETROSOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10420 OLD OLIVE STREET RD STE 305, SAINT LOUIS, MO 63141-5914
(314) 797-7074
(314) 227-5505
Mailing address
PO BOX 653, CHESTERFIELD, MO 63006-0653
(314) 797-7074
(314) 227-5505
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
036107203
IL
207RN0300X
Nephrology Physician
Primary
2002007108
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207235706
—
MO
Enumeration date
02/01/2006
Last updated
06/09/2024
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