Organization
ST LOUIS CARDIOLOGY CONSULTANTS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMER THANAVARO MD (MD)
(618) 433-1861
Entity
Organization
Contact information
Practice address
2 MEMORIAL DR STE 106, ALTON, IL 62002-6723
(618) 433-1861
(618) 433-9274
Mailing address
2 MEMORIAL DR STE 106, ALTON, IL 62002-6723
(618) 433-1861
(618) 433-9274
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1020549
CAREPARTNERS
—
01
—
219678300
OWCP
—
01
—
2629958
BC/BS
IL
01
—
30946
HEALTH PARTNERS
—
01
—
3831
CMR / GHP
—
05
—
500347406
—
MO
01
—
8816
HC USA
—
01
—
C50434
MORRMCR
MO
01
—
CJ3315
ILRRMCR
IL
Enumeration date
06/19/2006
Last updated
08/11/2021
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