Healthcare Provider Details

I. General information

NPI: 1154936888
Provider Name (Legal Business Name): DR. STEPAN SNITCAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S NEW BALLAS RD STE 7020
SAINT LOUIS MO
63141-8218
US

IV. Provider business mailing address

10841 CHASE PARK LN APT E
SAINT LOUIS MO
63141-5731
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6486
  • Fax: 314-251-4155
Mailing address:
  • Phone: 667-234-3120
  • Fax: 667-234-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2023007660
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: