Provider Demographics
NPI:1124093810
Name:FRATTINI, JOHN E (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:FRATTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12919 TUNDRA CT.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1319
Mailing Address - Country:US
Mailing Address - Phone:314-504-0827
Mailing Address - Fax:
Practice Address - Street 1:232 S. WOODSMILL ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-434-1500
Practice Address - Fax:314-542-4891
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6H05207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00351212OtherRR MEDICARE
MO203291737Medicaid
MOE41344Medicare UPIN
MO203291737Medicaid
MO016013481Medicare ID - Type Unspecified