MEDICARE: DR. KEITH HUNTER NUNNELEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	R6367	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3510	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144215070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH HUNTER NUNNELEE M.D.

Provider Business Mailing Address
First Line	:	222 S WOODS MILL RD
Second Line	:	SUITE 400 NORTH
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3625
Country	:	US
Telephone Number	:	314-878-5557
Fax Number	:	314-878-7661

Provider Business Practice Location Address
First Line	:	222 S WOODS MILL RD
Second Line	:	SUITE 400 NORTH
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3625
Country	:	US
Telephone Number	:	314-878-5557
Fax Number	:	314-878-7661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/08/2007

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