Organization
RENEWED HEALTH 180 LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDRACHUR BANERJEE (AUTHORIZED OFFICIAL)
(314) 866-9940
Entity
Organization
Contact information
Practice address
456 N NEW BALLAS RD STE 101A, CREVE COEUR, MO 63141-6831
(314) 866-9940
Mailing address
456 N NEW BALLAS RD STE 101A, CREVE COEUR, MO 63141-6831
(314) 866-9940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/19/2022
Last updated
01/19/2022
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