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NPI Code Detail

MEDICARE: DR. KENNETH ERNEST MARCINIAK AUD

MEDICARE: DR. KENNETH ERNEST MARCINIAK AUD
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
1231H00000XAudiologist2010020892MO

Other Identifiers

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

General Provider Information

NPI Number : 1477864072
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH ERNEST MARCINIAK AUD
Provider Business Mailing Address
First Line : 1010 OLD DES PERES RD
Second Line :
City : DES PERES
State : MO
Zip : 63131-1865
Country : US
Telephone Number : 314-722-4280
Fax Number : 314-729-0101
Provider Business Practice Location Address
First Line : 607 S NEW BALLAS RD STE 2300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8234
Country : US
Telephone Number : 314-251-6394
Fax Number : 314-251-4235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2010
Last Update Date : 07/21/2022

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