Healthcare Provider Details

I. General information

NPI: 1649236357
Provider Name (Legal Business Name): VINCENT SOLLECITO III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 WATSON RD 200
SAINT LOUIS MO
63109-1251
US

IV. Provider business mailing address

3915 WATSON RD 200
SAINT LOUIS MO
63109-1251
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-2711
  • Fax: 314-644-5081
Mailing address:
  • Phone: 314-352-2711
  • Fax: 314-644-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00449
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: