Individual
HENRY CHARLES IDEKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1225 S GRAND BLVD, GARDEN LEVEL, DOOR 3, ST LOUIS, MO 63104
(314) 577-8884
Mailing address
1008 S SPRING AVE STE 3300, SAINT LOUIS, MO 63110-2520
(314) 617-3955
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2025029856
MO
207Y00000X
Otolaryngology Physician
MT231592
PA
207YS0012X
Sleep Medicine (Otolaryngology) Physician
MT231592
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/26/2019
Last updated
08/07/2025
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