| Doctor Name: | DR. EMILY DENISE FONDAHN |
| NPI Number: | 1609038074 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 2011012592 |
| Business Practice Address: | 4960 Childrens Pl Saint Louis, MO - 631101000 |
| Business Phone Number: | 3143625060 |
| Business Fax Number: | 3143625969 |
| Mailing Address: | 660 S Euclid Ave, C B 8121 SAINT LOUIS |
| State: | MO |
| Postal Code: | 631101010 |
| Phone Number: | 3143625060 |
| Fax Number: | 3143625969 |
| NPI Enumeration Date: | 06/27/2008 |
| NPI Last Update Date: | 11/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2011012592 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |