Healthcare Provider Details

I. General information

NPI: 1558626572
Provider Name (Legal Business Name): OMAR KUZEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 BELLEVUE AVE STE 500
RICHMOND HEIGHTS MO
63117-1843
US

IV. Provider business mailing address

1035 BELLEVUE AVE STE 500
SAINT LOUIS MO
63117-1843
US

V. Phone/Fax

Practice location:
  • Phone: 314-925-4773
  • Fax:
Mailing address:
  • Phone: 314-925-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2016023342
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: