Provider Demographics
NPI:1295738201
Name:STICKLEY, LOUIS P (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:P
Last Name:STICKLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:625 S NEW BALLAS RD
Mailing Address - Street 2:STE 2030
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8253
Mailing Address - Country:US
Mailing Address - Phone:314-251-1700
Mailing Address - Fax:314-251-5804
Practice Address - Street 1:625 S NEW BALLAS RD
Practice Address - Street 2:STE 2030
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8253
Practice Address - Country:US
Practice Address - Phone:314-251-1700
Practice Address - Fax:314-251-1701
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO30591207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20088619Medicaid
MOA13195Medicare UPIN