Healthcare Provider Details

I. General information

NPI: 1588007751
Provider Name (Legal Business Name): KINSEY DINNEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 07/26/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD FL 6
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD FL 6
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7498
  • Fax:
Mailing address:
  • Phone: 314-251-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2017007788
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: