Provider Demographics
NPI:1750495099
Name:THYSSEN, ERIK P (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:P
Last Name:THYSSEN
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 1:11525 OLDE CABIN RD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7146
Mailing Address - Country:US
Mailing Address - Phone:314-997-0554
Mailing Address - Fax:314-997-5086
Practice Address - Street 1:SPECIALISTS IN GASTROENTEROLOGY
Practice Address - Street 2:11525 OLDE CABIN ROAD
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-997-0554
Practice Address - Fax:314-997-5086
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR3P63207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203703103Medicaid
211593OtherHEALTHLINK
107244OtherBLUE CROSS/BLUE SHIELD
1059638OtherUHC
43076OtherGHP
100008440OtherRAILROAD MEDICARE
MO003012657OtherMEDICARE LEGACY
4288200OtherAETNA
MO203703103Medicaid