Provider Demographics
NPI:1568847689
Name:PASSANISI, EMANUELE
Entity type:Individual
Prefix:
First Name:EMANUELE
Middle Name:
Last Name:PASSANISI
Suffix:
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 1:8558 EAGER RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1435
Mailing Address - Country:US
Mailing Address - Phone:314-918-9100
Mailing Address - Fax:314-918-9101
Practice Address - Street 1:8558 EAGER RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1435
Practice Address - Country:US
Practice Address - Phone:314-918-9100
Practice Address - Fax:314-918-9101
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOHISIT 2015006763237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOHISIT 2015006763OtherHEARING AID DISPENSER LICENSE