Provider Demographics
NPI:1306164744
Name:ELISABETH HUELSKOETTER MD, LLC
Entity type:Organization
Organization Name:ELISABETH HUELSKOETTER MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUELSKOETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-489-0179
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE 360N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-469-4466
Mailing Address - Fax:636-787-0575
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 360N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-469-4466
Practice Address - Fax:636-787-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty