Healthcare Provider Details

I. General information

NPI: 1699189928
Provider Name (Legal Business Name): ESAD KIVERIC, D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE WASHINGTON UNIVERSITY ANESTHESIOLOGY
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

1 SAINT ELIZABETH BLVD
O FALLON IL
62269-1099
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5000
  • Fax:
Mailing address:
  • Phone: 618-234-2120
  • Fax: 618-641-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2014017163
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036149291
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: