Individual
DR. RHODERIC PETER MIRKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12122 TESSON FERRY RD, SAINT LOUIS, MO 63128-1772
(314) 849-0808
(314) 849-8983
Mailing address
12639 OLD TESSON RD, SUITE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
109865
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0900210
UNITED HEALTHCARE
MO
01
—
136643
GROUP HEALTH PLAN
MO
01
—
200046096
RAILROAD MEDICARE
MO
01
—
2102999001
CIGNA
MO
01
—
26919
BLUE CROSS BLUE SHIELD
MO
01
—
283694
HEALTHLINK
MO
01
—
951747
AETNA
MO
Enumeration date
05/17/2006
Last updated
03/16/2021
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