Healthcare Provider Details

I. General information

NPI: 1346208378
Provider Name (Legal Business Name): LAURENCE D GELSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10296 BIG BEND RD SUITE 205
KIRKWOOD MO
63122
US

IV. Provider business mailing address

215 DUNN RD
FLORISSANT MO
63031-7928
US

V. Phone/Fax

Practice location:
  • Phone: 314-315-9911
  • Fax:
Mailing address:
  • Phone: 314-315-9913
  • Fax: 314-872-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR6E96
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: