Organization
MARANATHA HEALTHCARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADELUOLA G LIPEDE M.D. (PRESIDENT)
(314) 522-1888
Entity
Organization
Contact information
Practice address
9231 W FLORISSANT AVE, SAINT LOUIS, MO 63136-1422
(314) 522-1888
(314) 522-9674
Mailing address
PO BOX 3980, CHESTERFIELD, MO 63006-3980
(314) 522-1888
(314) 522-9674
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
R7F89
MO
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
R7F89
MO
208VP0000X
Pain Medicine Physician
R7F89
MO
Other
Enumeration date
03/03/2010
Last updated
05/17/2010
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