Provider Demographics
NPI:1609075563
Name:CHEREJI, IOAN SR
Entity type:Individual
Prefix:
First Name:IOAN
Middle Name:
Last Name:CHEREJI
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 DOUGHERTY FERRY RD
Mailing Address - Street 2:STE 103
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3373
Mailing Address - Country:US
Mailing Address - Phone:636-825-0375
Mailing Address - Fax:636-825-0957
Practice Address - Street 1:2951 DOUGHERTY FERRY RD
Practice Address - Street 2:STE 103
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3373
Practice Address - Country:US
Practice Address - Phone:636-825-0375
Practice Address - Fax:636-825-0957
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5980940001Medicare NSC