| Organization Name: | SSM DEPAUL MEDICAL GROUP, INC. |
| NPI Number: | 1073880480 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURA PULLUM (BILLING MANAGER) |
| Mailing Address: | 2305 Georgia St Louisiana |
| State: | MO US |
| Postal Code: | 633532559 |
| Phone Number: | 3142910846 |
| Fax Number: | 5737546056 |
| NPI Enumeration Date: | 11/30/2011 |
| NPI Last Update Date: | 01/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |