Individual
DR. DMITRY FAMILTSEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 308-1301
(573) 202-2480
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 426-2182
(573) 426-5341
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
2018013507
MO
207RI0011X
Interventional Cardiology Physician
Primary
2018013507
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2013
Last updated
03/24/2021
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