Organization
MIDWEST MEDICAL ASSOCIATES INC
Active
Other names
Grandel Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEXANDER RUDOI MD (PHYSICIAN)
(314) 481-7030
Entity
Organization
Contact information
Practice address
4346 LOUGHBOROUGH AVE, SAINT LOUIS, MO 63116-2104
(314) 481-7030
(314) 481-7120
Mailing address
4346 LOUGHBOROUGH AVE, SAINT LOUIS, MO 63116-2104
(314) 481-7030
(314) 481-7120
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MO100186
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB2750
MEDICARE RAILROAD
MO
Enumeration date
07/14/2006
Last updated
11/13/2007
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