MEDICARE: DR. SUE SATEESHA M.D.

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
1	208000000X	Pediatrics Physician	R9B31	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1770545212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUE SATEESHA M.D.

Provider Business Mailing Address
First Line	:	1551 WALL ST
Second Line	:	SUITE 310
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3539
Country	:	US
Telephone Number	:	636-669-2268
Fax Number	:	636-669-2401

Provider Business Practice Location Address
First Line	:	1475 KISKER RD
Second Line	:	SUITE 200
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-8781
Country	:	US
Telephone Number	:	636-498-5830
Fax Number	:	636-498-5846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	06/21/2011

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