Provider Demographics
NPI:1194105981
Name:COLE, EMILY FAHRIG (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:FAHRIG
Last Name:COLE
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-273-3376
Mailing Address - Fax:888-665-8309
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 502
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-273-3376
Practice Address - Fax:888-665-8309
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024034587207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200030154Medicaid