Provider Demographics
NPI:1871596783
Name:STEIN, EDWARD SAMUEL (DPM)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:SAMUEL
Last Name:STEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4201 S CLOVERLEAF DR STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6438
Mailing Address - Country:US
Mailing Address - Phone:636-928-1240
Mailing Address - Fax:636-928-1242
Practice Address - Street 1:4201 S CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6438
Practice Address - Country:US
Practice Address - Phone:636-928-1240
Practice Address - Fax:636-928-1242
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000347213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T42855Medicare UPIN
MO000021079Medicare PIN