=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992029821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DALE M STEGEMAN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2010
-----------------------------------------------------
Last Update Date | 02/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16216 BAXTER RD STE 340
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-4770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-537-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16216 BAXTER RD STE 340
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-4770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-537-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DALE M STEGEMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 636-537-3100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 36313
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------