MEDICARE: DR. KELLE H MOLEY MD

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	207VE0102X	Reproductive Endocrinology Physician	R8P38	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205852449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLE H MOLEY MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	C B 8064
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-286-2400
Fax Number	:	314-286-2455

Provider Business Practice Location Address
First Line	:	4444 FOREST PARK AVE STE 3100
Second Line	:	STE 3100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2212
Country	:	US
Telephone Number	:	314-286-2400
Fax Number	:	314-286-2455

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/24/2018

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Directions to “ DR. KELLE H MOLEY MD” Practice Location

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