Organization
SOUTH ST LOUIS ORTHOPEDIC GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITCHELL M MIRBAHA MD (PRESIDENT)
(314) 638-8785
Entity
Organization
Contact information
Practice address
9815 MACKENZIE ROAD, ST LOUIS, MO 63123
(314) 638-8785
(314) 638-8788
Mailing address
9815 MACKENZIE ROAD, ST LOUIS, MO 63123
(314) 638-8785
(314) 638-8788
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501422901
—
MO
Enumeration date
11/07/2006
Last updated
10/01/2008
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