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General NPI Number Information
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NPI Number | 1063973972
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Entity Type | Individual
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Provider Name | HENRY CHARLES IDEKER MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1225 S GRAND BLVD GARDEN LEVEL, DOOR 3
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City | ST LOUIS
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State | MO
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Zip | 63104
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Country | US
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Telephone | 314-577-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 S SPRING AVE STE 3300
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2520
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Country | US
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Telephone | 314-617-3955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MT231592
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number | MT231592
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 2025029856
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License Number State | MO
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