Healthcare Provider Details

I. General information

NPI: 1952840845
Provider Name (Legal Business Name): STHOMAS SEHY DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MARTIN LUTHER KING DR SUITE 106
CENTRALIA IL
62801-3060
US

IV. Provider business mailing address

10430 PAGE AVE
SAINT LOUIS MO
63132-1228
US

V. Phone/Fax

Practice location:
  • Phone: 314-423-8811
  • Fax: 314-423-8824
Mailing address:
  • Phone: 314-423-8811
  • Fax: 314-423-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005192
License Number StateIL

VIII. Authorized Official

Name: DR. STEPHEN THOMAS SEHY
Title or Position: PHYSICIAN/ OWNER
Credential: DPM
Phone: 314-423-8811