Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | R5102 | MO |
NPI | 1205203833 |
---|---|
Provider Name | Dr. Joseph Sudekum |
First Address | Frontenac, MO 63131-2805 |
Second Address | Frontenac, MO 63131-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 31/08/2015 |