Organization
NORTHLAND ORTHOPEDIC GROUP
Active
Organization
NORTHLAND ORTHOPEDIC GROUP
Active
Other names
Northland Midamerica Orthopedics
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL D ROUSH MD (PRESIDENT)
(314) 837-5555
Entity
Organization
Contact information
Practice address
1150 GRAHAM RD, STE 102, FLORISSANT, MO 63031-8077
(314) 837-5555
(314) 837-6175
Mailing address
1150 GRAHAM RD STE 102, FLORISSANT, MO 63031-8077
(314) 837-5555
(314) 837-6175
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12261963
MO
Other
Enumeration date
07/24/2006
Last updated
12/07/2009
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