Healthcare Provider Details

I. General information

NPI: 1871599811
Provider Name (Legal Business Name): SHARI LEWIS KAMINSKY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 GRAHAM RD SUITE 3010
FLORISSANT MO
63031-8028
US

IV. Provider business mailing address

1224 GRAHAM RD SUITE 3010
FLORISSANT MO
63031-8028
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-0074
  • Fax: 314-355-0337
Mailing address:
  • Phone: 314-355-0074
  • Fax: 314-355-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000648
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: