Individual
DR. STEPHEN E. THIERAUF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1203 SMIZER MILL RD, STE 108, FENTON, MO 63026-3483
(636) 717-1340
(636) 717-1344
Mailing address
1203 SMIZER MILL RD, STE 108, FENTON, MO 63026-3483
(636) 717-1340
(636) 717-1344
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036109602
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204935407
—
MO
Enumeration date
12/28/2006
Last updated
03/03/2008
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