Individual
DR. TATYANA R DEMIDOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3635 VISTA AVE FDT3, ST LOUIS UNIVERSITY, ST LOUIS, MO 63110
(314) 577-8750
Mailing address
3635 VISTA FDT3, ST LOUIS UNIVERSITY, ST LOUIS, MO 63110
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01059495A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200253830
—
IN
Enumeration date
09/22/2005
Last updated
10/20/2009
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