Provider Demographics
NPI:1093392466
Name:STIPPICH, SIERRA J (MD)
Entity type:Individual
Prefix:DR
First Name:SIERRA
Middle Name:J
Last Name:STIPPICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1600 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1320
Mailing Address - Country:US
Mailing Address - Phone:314-918-8827
Mailing Address - Fax:314-918-9391
Practice Address - Street 1:1600 S BRENTWOOD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1301
Practice Address - Country:US
Practice Address - Phone:314-918-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024017975208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics