Healthcare Provider Details

I. General information

NPI: 1730233743
Provider Name (Legal Business Name): GEISTLER FAMILY FOOTCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12152 TESSON FERRY RD
SAINT LOUIS MO
63128
US

IV. Provider business mailing address

12700 SOUTHFORK RD SUITE 260
SAINT LOUIS MO
63128-3288
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-7600
  • Fax: 314-842-0106
Mailing address:
  • Phone: 314-849-7600
  • Fax: 314-849-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000612
License Number StateMO

VIII. Authorized Official

Name: MS. BONNIE L WEISS
Title or Position: ASST. SECRETARY/TREASURER
Credential:
Phone: 314-849-7600