Healthcare Provider Details

I. General information

NPI: 1457647927
Provider Name (Legal Business Name): STEPHANIE M GABATHULER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD STE 200
SAINT CHARLES MO
63304-8788
US

IV. Provider business mailing address

4500 MEMORIAL DR
BELLEVILLE IL
62226-5360
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-0326
  • Fax:
Mailing address:
  • Phone: 618-257-6220
  • Fax: 618-257-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036146284
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-146284
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number2023035677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: