MEDICARE: DR. THOMAS PATRICK KUCIEJCZYK-KERNAN 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	207Q00000X	Family Medicine Physician	R6J90	MO
2	2084P0015X	Psychosomatic Medicine Physician	R6J90	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

General Provider Information

NPI Number	:	1669478970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PATRICK KUCIEJCZYK-KERNAN M.D.

Provider Business Mailing Address
First Line	:	1717 BIDDLE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-3454
Country	:	US
Telephone Number	:	314-898-1700
Fax Number	:	314-814-8542

Provider Business Practice Location Address
First Line	:	3930 S BROADWAY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-4626
Country	:	US
Telephone Number	:	314-898-1700
Fax Number	:	314-814-8542

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/01/2016

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