Individual
DR. THOMAS J VITALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1031 BELLEVUE AVE, SUITE 300, SAINT LOUIS, MO 63117-1818
(314) 644-6300
(314) 644-2503
Mailing address
10777 SUNSET OFFICE DR, SUITE 300, SAINT LOUIS, MO 63127-1019
(314) 822-5900
(314) 822-5919
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
36097734
IL
208600000X
Surgery Physician
Primary
R9749
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020024920
RAILROAD MEDICARE
MO
05
—
201920816
—
MO
Enumeration date
01/16/2006
Last updated
11/24/2008
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