Basic Information
Provider Information
NPI: 1154382810
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COMENS
FirstName: STEPHEN
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1551 WALL ST
Address2: SUITE 310
City: SAINT CHARLES
State: MO
PostalCode: 633033539
CountryCode: US
TelephoneNumber: 6366692268
FaxNumber: 6366692401
Practice Location
Address1: 1551 WALL ST
Address2: 4TH FLOOR
City: SAINT CHARLES
State: MO
PostalCode: 633033539
CountryCode: US
TelephoneNumber: 6366692220
FaxNumber: 6366692401
Other Information
ProviderEnumerationDate: 03/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X36363MOY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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