MEDICARE: LEVI S KIRKLAND JR. 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	208600000X	Surgery Physician	036095002	IL
2	208600000X	Surgery Physician	R9J09	MO

General Provider Information

NPI Number	:	1720082233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEVI S KIRKLAND JR. M.D.

Provider Business Mailing Address
First Line	:	P O BOX 6193
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63006-6193
Country	:	US
Telephone Number	:	314-644-1411
Fax Number	:	314-644-1606

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD
Second Line	:	SUITE 694
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1223
Country	:	US
Telephone Number	:	314-644-1411
Fax Number	:	314-644-1606

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/15/2015

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