DR. JORGE LUIS GRANADILLO DE LUQUE (NPI# 1952717902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952717902 |
| Entity Type | Individual |
| Full Name | DR. JORGE LUIS GRANADILLO DE LUQUE |
| Credential | M.D. |
| Practice Address |
1 Childrens Pl Suite 3s34 Saint Louis MO 63110-1002 |
| Practice Telephone | 3144546006 |
| Practice Fax Number | 3144544102 |
| Mailing Telephone | 3144546006 |
| Mailing Fax Number | 3144544102 |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2020-02-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
2014018812 | MO | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 2014018812 | MO | Allopathic & Osteopathic Physicians |
| Street Address |
1 CHILDRENS PL SUITE 3S34 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669476495 | William Lee Johnson | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2005-06-09 |
| 1114527033 | Kristin Kueper | Dietitian, Registered | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-29 |
| 1609474055 | Courtney Tompkins | Audiologist | 1 Childrens Pl, Saint Louis, MO 63110-1081 | 2020-10-16 |
| 1164036851 | Andrea Bumb | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-09-01 |
| 1235741513 | Shannon Ries | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1144832320 | Lacey Bender | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-19 |
| 1699386417 | Kristen Bagby | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-08-14 |
| 1720696115 | Abigail Patricia Klatch | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-21 |
| 1518575422 | St Louis Childrens Hospital | Clinical Medical Laboratory | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-16 |
| 1730707068 | Alyssa Lavalle | Nurse Practitioner | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2020-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447269444 | Gary S Gottesman | Medical Genetics | 4400 Clayton Ave, Research Center, Saint Louis, MO 63110-1624 | 2006-08-07 |
| 1295180867 | Catherine Gooch | Medical Genetics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2016-05-02 |
| 1780064378 | Katherine Barnes Abell | Medical Genetics | 1 Childrens Pl, Div Ped Cardiology, Saint Louis, MO 63110-1002 | 2015-06-09 |
| 1710116207 | Jennifer Michelle Heeley | Medical Genetics | 621 S New Ballas Rd, Suite 281a, Saint Louis, MO 63141-8232 | 2009-07-06 |
| 1225203672 | Beth Ann Kozel | Medical Genetics | 1 Childrens Pl Ste C, Ste C, Saint Louis, MO 63110-1002 | 2008-04-28 |
| 1780888644 | Patricia Irene Dickson | Medical Genetics | 1 Childrens Pl, Ste C, Saint Louis, MO 63110-1002 | 2007-06-13 |
| 1053523845 | St Louis University | Medical Genetics | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2007-05-04 |
| 1912087354 | Marwan Shinawi | Medical Genetics | 1 Childrens Pl Ste C, Ste C, Saint Louis, MO 63110-1002 | 2006-10-17 |
| 1871510313 | Rick A Martin | Medical Genetics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2006-07-17 |
| 1447278916 | Diana Lee Gray | Medical Genetics | 4901 Forest Park Ave Ste 710, Ste 710, Saint Louis, MO 63108-1402 | 2006-07-17 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
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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.