Healthcare Provider Details

I. General information

NPI: 1720060718
Provider Name (Legal Business Name): RANDALL STERKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N OUTER 40 RD STE 320
TOWN AND COUNTRY MO
63017-5941
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-7337
  • Fax: 314-851-4476
Mailing address:
  • Phone: 314-567-7337
  • Fax: 314-851-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number103720
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: