Individual
SEAN LEWIS EDELSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1225 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 977-5200
(314) 977-9910
Mailing address
1008 S SPRING AVE, SAINT LOUIS, MO 63110-2520
(314) 977-4010
(314) 977-3495
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2005019369
MO
207R00000X
Internal Medicine Physician
2005019369
MO
207W00000X
Ophthalmology Physician
Primary
2005019369
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679520605
—
MO
05
—
200839009
—
MO
Enumeration date
05/27/2006
Last updated
01/19/2021
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