Provider Demographics
NPI:1265481352
Name:ZEISSET, CHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:ZEISSET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 GRAHAM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8077
Mailing Address - Country:US
Mailing Address - Phone:314-830-4001
Mailing Address - Fax:314-830-4647
Practice Address - Street 1:1150 GRAHAM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8077
Practice Address - Country:US
Practice Address - Phone:314-830-4001
Practice Address - Fax:314-830-4647
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7J52207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE75784Medicare UPIN