Healthcare Provider Details

I. General information

NPI: 1174010037
Provider Name (Legal Business Name): STEPHEN JOSEPH SATTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WEST SOUTH STREET MORROW 125
WARRENSBURG MO
64093
US

IV. Provider business mailing address

2602 DEWEY LN
COLUMBIA MO
65202-9188
US

V. Phone/Fax

Practice location:
  • Phone: 660-543-4256
  • Fax:
Mailing address:
  • Phone: 573-355-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: