Healthcare Provider Details

I. General information

NPI: 1356285787
Provider Name (Legal Business Name): SS VIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 BEAUWOOD CT
SAINT LOUIS MO
63132
US

IV. Provider business mailing address

9506 OLIVE BLVD # 214
SAINT LOUIS MO
63132-3104
US

V. Phone/Fax

Practice location:
  • Phone: 314-527-1358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SAUK
Title or Position: OWNER, PHYSICIAN
Credential: MD
Phone: 314-527-1357