Provider Demographics
NPI: | 1235578956 |
---|---|
Name: | GENERE, NATALIA (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | NATALIA |
Middle Name: | |
Last Name: | GENERE |
Suffix: | |
Gender: | F |
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: | 314-362-3500 |
Mailing Address - Fax: | 314-230-1119 |
Practice Address - Street 1: | 4921 PARKVIEW PL |
Practice Address - Street 2: | DIV IM ENDOCRINOLOGY, STE 5C |
Practice Address - City: | SAINT LOUIS |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63110-1032 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-362-3500 |
Practice Address - Fax: | 314-230-1119 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2013-06-15 |
Last Update Date: | 2025-04-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2020022489 | 207R00000X, 207RE0101X |
MO | 2001029511 | 207RE0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 200087424 | Medicaid |