Organization
PANIAGUA MEDICAL LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL A PANIAGUA MD (OWNER)
(314) 741-2500
Entity
Organization
Contact information
Practice address
12414 LUSHER RD, SAINT LOUIS, MO 63138-1456
(314) 741-2500
(314) 741-0880
Mailing address
1532 FOUNTAINHEAD LN, SAINT LOUIS, MO 63138-3339
(314) 741-2500
(314) 741-0880
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R4B44
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2606
BCBS
MO
01
—
54724
HCUSA
MO
01
—
5709126
AETNA
MO
Enumeration date
01/04/2008
Last updated
01/04/2008
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