Provider Demographics
NPI:1487735247
Name:OLLINGER, HENRY G (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:G
Last Name:OLLINGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-872-7800
Mailing Address - Fax:314-872-7801
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 210B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-872-7800
Practice Address - Fax:314-872-7801
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO33499208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA-11011Medicare UPIN