Healthcare Provider Details

I. General information

NPI: 1174234348
Provider Name (Legal Business Name): DREW KOCHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RIOTT KOCHMAN

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S KINGSHIGHWAY BLVD FL 2
SAINT LOUIS MO
63139-1003
US

IV. Provider business mailing address

5119 JAMIESON AVE # A
SAINT LOUIS MO
63109-3031
US

V. Phone/Fax

Practice location:
  • Phone: 314-296-3222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: