Healthcare Provider Details

I. General information

NPI: 1780601229
Provider Name (Legal Business Name): STEVEN A EDMUNDOWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8124
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone: 314-454-5960
  • Fax: 314-454-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR1F46
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: