DR. ALFREDO CUSTODIO (NPI# 1144427469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144427469 |
| Entity Type | Individual |
| Full Name | DR. ALFREDO CUSTODIO |
| Credential | M.D. |
| Practice Address |
11133 Dunn Rd Saint Louis MO 63136-6119 |
| Practice Telephone | 3146535744 |
| Practice Fax Number | 3146535613 |
| Mailing Telephone | 3146535744 |
| Mailing Fax Number | 3146535613 |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2007-10-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | MDR7797 | MO | Allopathic & Osteopathic Physicians |
| Street Address |
11133 DUNN RD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63136-6119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659376390 | John Oldham | Emergency Medicine | 11133 Dunn Rd, Rm H2241, Saint Louis, MO 63136-6119 | 2005-06-18 |
| 1750988499 | Lindsey Onate | Dietitian, Registered | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-10-06 |
| 1548878705 | Christian Hospital Northeast Northwest | Clinical Medical Laboratory | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-07-14 |
| 1962028555 | Wayne Joseph Parks | Spec/Tech, Pathology | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-06-19 |
| 1295368504 | Rebecca Lynne Mooshegian Brewer | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-02-14 |
| 1114568821 | Kelly Ann Blanner | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2019-10-03 |
| 1235790957 | Kelly Anderson Erlinger | Anesthesiologist Assistant | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2019-06-24 |
| 1053896654 | Hermance Fortune | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2018-09-28 |
| 1801376884 | Andrea Lynn Thurm | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2018-08-18 |
| 1831675545 | Kyle Patrick Mclafferty | Physician Assistant | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2018-07-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518565993 | Dorothy Smith | Home Health | 2531 Nathan Drive, St Louis, MO 63136 | 2020-10-16 |
| 1538784459 | Rita D Wilson | Technician | 9597 Jacobi Ave Bldg 33 Apt 7, Saint Louis, MO 63136 | 2020-06-16 |
| 1922646728 | Eduhealth Personal Care Services | Technician | 5843 Eagle Valley Dr Saint Louis Mo 63136, Saint Louis, MO 63136 | 2019-12-12 |
| 1558912964 | Homers Haven Home Care LLC | Home Health | 5636 Pamplin Pl, St Louis, MO 63136 | 2019-09-26 |
| 1366096703 | Chloe Suzanne Datillo | Nurse Practitioner | 2865 Netherton Dr., St Louis, MO 63136 | 2019-07-24 |
| 1053976431 | U Auto Be Quik LLC | Non-emergency Medical Transport (VAN) | 10352 Castle Drive, St. Louis, MO 63136 | 2019-05-01 |
| 1164945895 | A Plus Home Health Services LLC | Home Health | 9517 Wilson Bridge Drive, Saint Louis, MO 63136 | 2017-07-25 |
| 1184150302 | Fairview Village Adult Day Care LLC | Clinic/Center | 8449 Jennings Station Rd, Fairview Village Adult Day Care, Saint Louis, MO 63136 | 2017-05-08 |
| 1023541182 | Lots of Love Home Health Services | In Home Supportive Care | 4144 Lindell Blvd. Suite 218, Saint Louis, MO 63136 | 2017-04-06 |
| 1912440876 | Carestl Health | Clinic/Center | 7047 Emma Ave, Jennings, MO 63136 | 2016-11-28 |
| Find all providers in zip 63136 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003336934 | Bradley Kushner | Surgery | 660 S Euclid Ave Fl 9, Saint Louis, MO 63110-1010 | 2017-06-21 |
| 1982088571 | Maxwell Tanyi Fohtung | Surgery | 4949 W Pine Blvd, Saint Louis, MO 63108 | 2015-07-14 |
| 1376920538 | Jordan M Kirsch | Surgery | 660 S. Euclid Ave, Cb 8109, Saint Louis, MO 63110-1020 | 2015-04-27 |
| 1003231002 | Mysorekar Surgical | Surgery | 8342 Delcrest Dr, Apt 303, Saint Louis, MO 63124-2100 | 2014-02-27 |
| 1962765974 | Lauren K. M. Barron | Surgery | 7421 Nottingham Ave, Saint Louis, MO 63119-3341 | 2012-06-25 |
| 1831452952 | Bola Gabriel Aladegbami | Surgery | 4901 Forest Park Ave Ste 630, Mail Stop 90-75-587, Saint Louis, MO 63108-1444 | 2012-06-22 |
| 1235491663 | Andrew Yeh | Surgery | 1 Childrens Pl Ste 6110, Saint Louis, MO 63110-1002 | 2012-06-12 |
| 1922310481 | Radhika Kausalya Smith | Surgery | 1040 N Mason Rd Ste 120, Ste 120, Saint Louis, MO 63141-6361 | 2010-07-12 |
| 1730316290 | Katherine Glover-collins | Surgery | 4921 Parkview Pl Ste 5f, Ste 5f, Saint Louis, MO 63110-1032 | 2009-06-11 |
| 1245473156 | Nishant Raj | Surgery | 11155 Dunn Rd Ste 108n, Saint Louis, MO 63136-6148 | 2009-04-08 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63136 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.