DR. DMITRY FAMILTSEV


Address: 1050 W 10th St, Rolla, MO 65401-2905
Phone: 5733081301

DR. DMITRY FAMILTSEV (NPI# 1194161174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1194161174
Entity Type Individual
Full Name DR. DMITRY FAMILTSEV
Credential M.D., PH.D.
Practice Address 1050 W 10th St
Rolla
MO 65401-2905
Practice Telephone 5733081301
Practice Fax Number 5732022480
Mailing Telephone 5734262182
Mailing Fax Number 5734265341
Enumeration Date 2013-05-16
Last Update Date 2019-08-21
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207RC0000X Internal Medicine
Specialization: Cardiovascular Disease
2018013507 MO Allopathic & Osteopathic Physicians
Y 207RI0011X Internal Medicine
Specialization: Interventional Cardiology
2018013507 MO Allopathic & Osteopathic Physicians
N 390200000X Student in an Organized Health Care Education/Training Program Student, Health Care

Provider Secondary Practice Location

Address Telephone Number Fax Number
1501 N Campbell Ave, Tucson, AZ 857240001 5206261416 5206264333
1050 W 10th St, Rolla, MO 654012905 5733081301 5732022480

Office Location

Street Address 1050 W 10TH ST
City ROLLA
State MO
Zip Code 65401-2905

Providers in the same location

NPI Name Taxonomy Address Enumeration
1518962570 Donald James Mcmullin Internal Medicine 1050 W 10th St, Rolla, MO 65401 2005-06-16
1366066037 Pcrmc Medical Group, Inc Clinic/Center 1050 W 10th St, Rolla, MO 65401-2905 2020-05-29
1659857415 Josie Leann Eoff Nurse Practitioner 1050 W 10th St, Rolla, MO 65401 2018-07-16
1659893758 Joshua Thomas Turnbaugh Nurse Practitioner 1050 W 10th St, Rolla, MO 65401 2017-07-10
1700327897 Emily Wiseman Nurse Practitioner 1050 W 10th St, Rolla, MO 65401 2017-03-09
1487046181 Pamela N. Gray Physician Assistant 1050 W 10th St, Rolla, MO 65401-2905 2015-03-04
1174928857 Arezo Hesaraki Dentist 1050 W 10th St, Ste 480, Rolla, MO 65401-2905 2014-10-23
1922416296 Karen Ulrich Advanced Practice Midwife 1050 W 10th St, Rolla, MO 65401-2905 2014-07-30
1093142531 Meredith Leigh Napierala Nurse Practitioner 1050 W 10th St, Rolla, MO 65401-2905 2013-09-30
1528409638 Curtis Morrison Internal Medicine 1050 W 10th St, Rolla, MO 65401-2905 2013-07-17
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1639645591 Samantha Jo Mitchell Pharmacist 1375 E 10th St Suite B, Rolla, MO 65401 2018-10-18
1427567726 Gerry Wade Funkhouser Jr. Counselor 103 W 10th St, Rolla, MO 65401 2017-09-29
1366967960 Shana Hintz Wisniewski Social Worker 1000 W. 10th St., Rolla, MO 65401 2017-08-04
1174066559 Tabitha Hundt Counselor 1011 Cypress Dr, Rolla, MO 65401 2016-12-02
1841742855 Alpha Assisted Living LLC Assisted Living Facility 13450 Cr 7040, 803 E 12th St, Rolla, MO 65401 2016-10-26
1275916884 Elizabeth Zersen Occupational Therapist 2053 Vienna Rd, Rolla, MO 65401 2015-06-30
1386047025 Becky L Witham Nurse Practitioner 1060 W 10th Street, Rolla, MO 65401 2014-10-08
1114326121 Summer Adey Licensed Practical Nurse 13750 State Route F, Rolla, MO 65401 2014-08-14
1518303296 Leaetta Mildred Gardner Nursing Facility/Intermediate Care Facility 13450 County Road 7040, Rolla, MO 65401 2013-05-21
1316282064 Susan Peitz Gruener Occupational Therapy Assistant 1800 White Column Road, Rolla, MO 65401 2012-12-06
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Taxonomy Information

Taxonomy Code 207RI0011X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Interventional Cardiology

Taxonomy Definition

An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine)

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1114215134 Arslan Shaukat Internal Medicine 1000 W 10th St, Rolla, MO 65401 2011-07-11
1063411999 James J Spadaro Jr. Internal Medicine 1050 W 10th St, Rolla, MO 65401-2905 2005-07-21

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1275032286 Cardiac Cin of Kansas City LLC Internal Medicine 111 W 10th St Ste 103, Kansas City, MO 64105-1700 2018-02-05
1437658440 Cardiac Cin of St Louis LLC Internal Medicine 11628 Old Ballas Rd # 346, Saint Louis, MO 63141-7030 2018-02-05
1629366984 Jorge Marcelo Ramirez Romero Internal Medicine 1402 S. Grand, Fdt 14th Floor, St. Louis, MO 63104 2011-07-20
1164737490 Mohan Mallikarjuna Edupuganti Internal Medicine 901 Patients First Dr Ste 2500, Washington, MO 63090 2010-08-11
1285945295 Byungsoo Ko Internal Medicine 100 Mercy Way Ste 320, Joplin, MO 64804-4524 2010-06-24
1033370358 Shamail S. Tariq Internal Medicine 1071 Airport Rd, Festus, MO 63028-4103 2008-06-19
1104083351 Cardiovascular Institute of Jacksonville P A Internal Medicine 1406 Ridgetree Trails Dr, Wildwood, MO 63021-5930 2008-05-16
1053401422 Gus Theodos Internal Medicine 710 S Price Rd, Saint Louis, MO 63124-1867 2006-10-13
1225134117 William R Reilly Inc Internal Medicine 450 N. New Ballas Rd, Ste 170w, St. Louis, MO 63141-6835 2006-09-16
1881799336 Morton R. Rinder Internal Medicine 222 S Woods Mill Rd Ste 560, Chesterfield, MO 63017-3625 2006-09-13
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Competitor

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City ROLLA
Zip Code 65401

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Dataset Information

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.

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