Provider Demographics
NPI:1386609204
Name:AMARNEK, DAVID L (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:AMARNEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 REAVIS BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3260
Mailing Address - Country:US
Mailing Address - Phone:314-487-9300
Mailing Address - Fax:314-487-9338
Practice Address - Street 1:1299 REAVIS BARRACKS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3260
Practice Address - Country:US
Practice Address - Phone:314-487-9300
Practice Address - Fax:314-487-9338
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0000481213ES0103X
IL016003754213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO301913133Medicaid
MO301913133Medicaid
MOT42886Medicare UPIN