Healthcare Provider Details

I. General information

NPI: 1770545212
Provider Name (Legal Business Name): SUE SATEESHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD SUITE 200
SAINT CHARLES MO
63304-8781
US

IV. Provider business mailing address

1551 WALL ST SUITE 310
SAINT CHARLES MO
63303-3539
US

V. Phone/Fax

Practice location:
  • Phone: 636-498-5830
  • Fax: 636-498-5846
Mailing address:
  • Phone: 636-669-2268
  • Fax: 636-669-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR9B31
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: