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NPI Code Detail

MEDICARE: DR. STEPHANIE L SANDBERG D.O.

MEDICARE: DR. STEPHANIE L SANDBERG D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician2004012744MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649273160
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE L SANDBERG D.O.
Provider Business Mailing Address
First Line : 670 MASON RIDGE CENTER DR
Second Line : STE 300
City : SAINT LOUIS
State : MO
Zip : 63141-8573
Country : US
Telephone Number : 636-344-1073
Fax Number : 636-344-1075
Provider Business Practice Location Address
First Line : 20 PROGRESS POINT PKWY
Second Line : SUITE 206
City : O FALLON
State : MO
Zip : 63368-2206
Country : US
Telephone Number : 636-344-1073
Fax Number : 636-344-1075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2005
Last Update Date : 02/04/2021

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Directions to “ DR. STEPHANIE L SANDBERG D.O.” Practice Location

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