Provider Demographics
NPI:1679680821
Name:SOLOMON, STEVEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:SOLOMON
Suffix:
Gender:M
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:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-5170
Mailing Address - Fax:314-996-4261
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:DEPT RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5170
Practice Address - Fax:314-996-4261
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4J722085R0202X
IL0360877152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203180104Medicaid
E40871OtherGATE WAY
006013128OtherCARE
006013128OtherMO CARE
1600229OtherPH PLAN
300066985OtherRR CARE
398019OtherHLT PART
431725842MIDOtherMERCY
006012444OtherCARE
1082789OtherMC MCAID
1390OtherMO BLUE
0090000352OtherIL BLUE
203180104OtherMO CAID
26030OtherBLUE CHOICE
150063OtherH LINK
7142OtherHCARE USA
E40871OtherGATE WAY
1390OtherMO BLUE