CHOTCHAI SRISURO, M.D., INC. (NPI# 1467688937) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467688937 |
| Entity Type | Organization |
| Organization Name | CHOTCHAI SRISURO, M.D., INC. |
| Practice Address |
1011 Bowles Ave Suite G10 Fenton MO 63026-2387 |
| Practice Telephone | 6364965450 |
| Practice Fax Number | 6364964963 |
| Mailing Telephone | 6364965450 |
| Mailing Fax Number | 6364964963 |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2009-06-10 |
| Authorized Official Name | DR. CHOTCHAI SRISURO (PRESIDENT) |
| Authorized Official Telephone | 3145183665 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
33186 | MO | Allopathic & Osteopathic Physicians |
| Street Address |
1011 BOWLES AVE SUITE G10 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-2387 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710979208 | Cesar Fernando Munoz | Internal Medicine | 1011 Bowles Ave, Ste. 300, Fenton, MO 63026-2395 | 2005-08-19 |
| 1083120208 | Tiffany Shanta Harold | Nurse Practitioner | 1011 Bowles Ave, Fenton, MO 63026-2395 | 2017-12-26 |
| 1093250334 | Laura Ann Rogers | Registered Nurse | 1011 Bowles Ave, Ste 220, Fenton, MO 63026-2395 | 2016-12-22 |
| 1124579966 | Ssm Medical Group Inc. | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2395 | 2016-10-17 |
| 1699158196 | Diane Denise Block | Nurse Practitioner | 1011 Bowles Ave, Suite 300, Fenton, MO 63026-2395 | 2015-07-01 |
| 1992196992 | Tara Joann Knoepp | Physical Therapist | 1011 Bowles Ave, Suite 150, Fenton, MO 63026-2395 | 2015-02-11 |
| 1093129538 | Elizabeth Anne Rancour | Dermatology | 1011 Bowles Ave, Ste 121, Fenton, MO 63026 | 2014-06-12 |
| 1558799742 | Amanda Nicole Meitz | Nurse Practitioner | 1011 Bowles Ave, Suite 205, Fenton, MO 63026-2395 | 2013-10-24 |
| 1013253699 | Lita Lapins | Nurse Practitioner | 1011 Bowles Ave, Suite 300, Fenton, MO 63026 | 2012-12-30 |
| 1043568280 | Denise P Blackburn | Registered Nurse | 1011 Bowles Ave, Suite G10, Fenton, MO 63026-2395 | 2012-08-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
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| Taxonomy Code | 207VX0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecologic Oncology |
| An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255395687 | Alaa A Elbendary | Obstetrics & Gynecology | 11652 Studt Ave, Saint Louis, MO 63141-7025 | 2006-04-13 |
| 1154385417 | Kevin O Easley | Obstetrics & Gynecology | 12855 North Forty Dr, Suite 200, St Louis, MO 63141 | 2006-04-13 |
| 1154393411 | Dan-arin Silasi | Obstetrics & Gynecology | 607 S New Ballas Rd Ste 2350, Saint Louis, MO 63141-0001 | 2006-02-02 |
| 1366423360 | Leslie S Massad | Obstetrics & Gynecology | 4921 Parkview Pl Ste 13c, Ste 13c, Saint Louis, MO 63110-1032 | 2005-11-08 |
| 1104813633 | Nishan Chobanian Jr. | Obstetrics & Gynecology | 607 S New Ballas Rd, Saint Louis, MO 63141-8222 | 2005-09-30 |
| 1639176290 | Donald Clayton Patterson | Obstetrics & Gynecology | 503 E Nifong Blvd # 217, Columbia, MO 65201-3792 | 2005-06-28 |
| 1386079481 | Melissa Schwartz | Obstetrics & Gynecology | 1031 Bellevue Ave Ste 400, Saint Louis, MO 63117-1858 | 2013-09-08 |
| 1174835136 | Blair Smith | Obstetrics & Gynecology | 2340 E Meyer Blvd Ste 546, Kansas City, MO 64132-1110 | 2010-07-07 |
| 1386960359 | Michelle Renee Rowland | Obstetrics & Gynecology | 4321 Washington St, Kansas City, MO 64111-5905 | 2010-04-15 |
| 1740462316 | Katherine Cynthia Fuh | Obstetrics & Gynecology | 4921 Parkview Pl Ste 13c, Ste 13c, Saint Louis, MO 63110-1032 | 2007-12-05 |
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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.