Graduated: 2016
NPI: 1093250334
Practice Locations (2)
IMPACT PHYSICIAN GROUP MISSOURI LLC
12380 DEPAUL DR
BRIDGETON, MO 630442511
3144479700
IMPACT PHYSICIAN GROUP MISSOURI LLC
10114 KENNERLY RD
SAINT LOUIS, MO 631282183
3149482000
Source: CMS National Downloadable File, September 2026.