Healthcare Provider Details

I. General information

NPI: 1306222518
Provider Name (Legal Business Name): CHESTERFIELD VALLEY INTERNAL MEDICINE & PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SAINT LUKES CENTER DR ATTN: RICK SONNE
CHESTERFIELD MO
63017-3509
US

IV. Provider business mailing address

121 SAINT LUKES CENTER DR ATTN: RICK SONNE
CHESTERFIELD MO
63017-3509
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-2490
  • Fax: 314-576-2344
Mailing address:
  • Phone: 314-576-2490
  • Fax: 314-576-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RICK SONNE
Title or Position: DIRECTOR
Credential:
Phone: 314-576-2490