Individual
DR. DALE M HENSELMEIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12255 DE PAUL DR, SUITE 600, BRIDGETON, MO 63044-2510
(314) 291-1074
(314) 290-0802
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-2510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R8831
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00075900
RAILROAD MEDICARE
MO
Enumeration date
02/09/2006
Last updated
10/22/2020
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