Thanavaro, Samer
Thanavaro, Samer is an individual health care provider with primary practice located at 11125 Dunn Rd Suite 204, Saint Louis MO 63136-6132. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Thanavaro, Samer can be contacted via phone (314) 839-5522.Contact Information
Primary practice address
11125 Dunn Rd Suite 204
Saint Louis MO 63136-6132
Phone: (314) 839-5522
Fax: (314) 839-5351
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 036072313 | Illinois |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | R6765 | Missouri |
Profile Details
| NPI number | 1619960606 |
|---|---|
| LBN Legal business name | Thanavaro, Samer |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 25th, 2005 |
| Last updated | Dec 2nd, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619960606 | NPPES |
| Illinois | Other | 060067960 | ILRRMCR |
| Illinois | Other | 110099256 | ILRRMCR |
| Illinois | Other | 431098908 | ILRRMCR |
| Illinois | Other | 2500083 | ILRRMCR |
| Illinois | Other | A13504 | ILRRMCR |
| Illinois | Other | 2333V3831 | ILRRMCR |
| Illinois | Other | 000000012939 | ILRRMCR |
| Illinois | Other | 7268V8816 | ILRRMCR |
| Illinois | MEDICAID | 200998417 | ILRRMCR |
| Illinois | Other | 119171 | ILRRMCR |
| Illinois | Other | 1259965 | ILRRMCR |
| Illinois | Other | 43336V30946 | ILRRMCR |
| Illinois | Other | 4037808 | ILRRMCR |
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