Organization
PRACTICE OF ROSEMARY CANNISTRARO, LLC
Active
Parent organization
ST. LUKE'S MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. LUKE'S MEDICAL GROUP
Authorized official
RICK SONNE (DIRECTOR)
(314) 576-2490
Entity
Organization
Contact information
Practice address
12609 OLIVE BLVD, SAINT LOUIS, MO 63141-6313
(314) 205-8344
(314) 205-0217
Mailing address
232 S WOODS MILL RD, CHESTERFIELD, MO 63017-3417
(314) 576-2490
(314) 576-2473
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD8725
RR MEDICARE
MO
Enumeration date
02/15/2007
Last updated
11/27/2007
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