Provider Demographics
NPI:1669525275
Name:SCHEIDLER, STEFAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:SCHEIDLER
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 1:301 SOUTH BYP
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3252
Mailing Address - Country:US
Mailing Address - Phone:573-888-0900
Mailing Address - Fax:573-888-9588
Practice Address - Street 1:301 SOUTH BYP
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3252
Practice Address - Country:US
Practice Address - Phone:573-888-0900
Practice Address - Fax:573-888-9588
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006036682207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208339309Medicaid