Healthcare Provider Details

I. General information

NPI: 1902198781
Provider Name (Legal Business Name): MATTHEW E SCHOENHERR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD STE. 406
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE. 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5484
  • Fax: 314-653-5483
Mailing address:
  • Phone: 314-653-5484
  • Fax: 314-653-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60064-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015018628
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: