Healthcare Provider Details

I. General information

NPI: 1710397393
Provider Name (Legal Business Name): SOLOMON SEIFU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOWLES AVE STE 300
FENTON MO
63026-2387
US

IV. Provider business mailing address

900 CATON AVE
BALTIMORE MD
21229
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-5065
  • Fax:
Mailing address:
  • Phone: 410-368-8858
  • Fax: 410-368-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMR155891
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMR155891
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2025012683
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number24706
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: