Healthcare Provider Details

I. General information

NPI: 1891747051
Provider Name (Legal Business Name): KIRPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9326 OLIVE BLVD
OLIVETTE MO
63132-3257
US

IV. Provider business mailing address

9326 OLIVE BLVD
OLIVETTE MO
63132-3257
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-5556
  • Fax: 314-576-9832
Mailing address:
  • Phone: 314-725-5556
  • Fax: 314-576-9832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36041
License Number StateMO

VIII. Authorized Official

Name: BINWANT K SINGH
Title or Position: MEMBER
Credential: M.D.
Phone: 314-725-5556