Healthcare Provider Details

I. General information

NPI: 1336127208
Provider Name (Legal Business Name): METRO FOOT SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N VIRGINIA AVE
EUREKA MO
63025-1115
US

IV. Provider business mailing address

62 E NORTH ST STE 101
EUREKA MO
63025-1205
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-5006
  • Fax: 636-587-3774
Mailing address:
  • Phone: 636-938-5006
  • Fax: 636-587-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KRA M KOZLOWSKI
Title or Position: DPM, FACFAS
Credential: DPM,
Phone: 636-938-5006