| Organization Name: | MARANATHA HEALTHCARE PC |
| NPI Number: | 1679896716 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ADELUOLA G LIPEDE (PRESIDENT) |
| Mailing Address: | 9231 W Florissant Ave Saint Louis |
| State: | MO US |
| Postal Code: | 631361422 |
| Phone Number: | 3145221888 |
| Fax Number: | 3145229674 |
| NPI Enumeration Date: | 03/03/2010 |
| NPI Last Update Date: | 05/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | R7F89 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |