Healthcare Provider Details

I. General information

NPI: 1013397751
Provider Name (Legal Business Name): THEODORE KREMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 DUNN RD STE 180
HAZELWOOD MO
63042-1759
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-838-7912
  • Fax: 314-921-6283
Mailing address:
  • Phone: 314-851-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018011910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: