Provider Demographics
NPI:1508978164
Name:RUMMEL, THEODORE S (DO)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:S
Last Name:RUMMEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2711
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:112 PIPER HILL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1690
Practice Address - Country:US
Practice Address - Phone:636-229-5900
Practice Address - Fax:636-229-5011
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MODO 101663207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000007467Medicare ID - Type UnspecifiedMEDICARE ID
MOF45193Medicare UPIN