Healthcare Provider Details

I. General information

NPI: 1013982818
Provider Name (Legal Business Name): MARY ANN DIMARSICO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN STEINKE DO

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W CLAY RD
VERSAILLES MO
65084-1177
US

IV. Provider business mailing address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

V. Phone/Fax

Practice location:
  • Phone: 877-733-5824
  • Fax: 888-979-8868
Mailing address:
  • Phone: 660-826-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2F10
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOR2F10
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: