1205839354 NPI number — DR. EMIL A DIFILIPPO M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	DIFILIPPO
Provider First Name	:	EMIL
Provider Middle Name	:	A
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1205839354
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	10/16/2009
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	9323 PHOENIX VILLAGE PKWY
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	O FALLON
Provider Business Mailing Address State Name	:	MO
Provider Business Mailing Address Postal Code	:	633664281
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	6365615030
Provider Business Mailing Address Fax Number	:	6365615033

Provider First Line Business Practice Location Address	:	400 1ST CAPITOL DR
Provider Second Line Business Practice Location Address	:	STE 100
Provider Business Practice Location Address City Name	:	SAINT CHARLES
Provider Business Practice Location Address State Name	:	MO
Provider Business Practice Location Address Postal Code	:	633012881
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6369467050
Provider Business Practice Location Address Fax Number	:	6369463368
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
Authorized Official Middle Name	:
Authorized Official Title or Position	:
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• Taxonomy code: 207X00000X , with the licence number:  30530 , registered in the state of MO .

• Identifier: 45619 . This is a "CMR" identifier . This identifiers is of the category "".
• Identifier: 351240001 . This is a "CIGNA DMERC" identifier . This identifiers is of the category "".
• Identifier: 6034V3458 . This is a "GHP/ADVANTRA" identifier . This identifiers is of the category "".
• Identifier: 990000528 , issued by the state of ( MO ) . This identifiers is of the category "".
• Identifier: 119066 . This is a "HEALTHLINK" identifier . This identifiers is of the category "".
• Identifier: 21646 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "".
• Identifier: 4432V6097 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "".
• Identifier: 9042 . This is a "EXCLUSIVE CHOICE" identifier . This identifiers is of the category "".
• Identifier: A10875 . This identifiers is of the category "".
• Identifier: 10015552 . This is a "RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "".
• Identifier: 4061313 . This is a "AETNA" identifier . This identifiers is of the category "".
• Identifier: 900093 . This is a "UHC" identifier . This identifiers is of the category "".
• Identifier: A10875 . This is a "MHP/PREMIER PLUS" identifier . This identifiers is of the category "".
• Identifier: SP10135 . This is a "CIGNA" identifier . This identifiers is of the category "".