Healthcare Provider Details

I. General information

NPI: 1598804155
Provider Name (Legal Business Name): ORTHOPEDIC SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 THE LEGENDS PKWY SUITE 100
EUREKA MO
63025-3818
US

IV. Provider business mailing address

PO BOX 790051
SAINT LOUIS MO
63179-0051
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-7888
  • Fax:
Mailing address:
  • Phone: 314-989-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CHABOT
Title or Position: PARTNER
Credential: DO
Phone: 314-909-1359