Healthcare Provider Details

I. General information

NPI: 1861831430
Provider Name (Legal Business Name): MARCUS HEMESATH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD OBGYN
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD OBGYN
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6462
  • Fax: 314-251-4492
Mailing address:
  • Phone: 314-251-6462
  • Fax: 314-251-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2013018115
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: