Healthcare Provider Details

I. General information

NPI: 1114016391
Provider Name (Legal Business Name): TODD BROOK SILVERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 NORTH OUTER 40 RD STE 330-B
CHESTERFIELD MO
63017-2119
US

IV. Provider business mailing address

14825 NORTH OUTER 40 RD STE 330-B
CHESTERFIELD MO
63017-2119
US

V. Phone/Fax

Practice location:
  • Phone: 636-537-0525
  • Fax: 636-537-0575
Mailing address:
  • Phone: 636-537-0525
  • Fax: 636-537-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2001012251
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: