Healthcare Provider Details

I. General information

NPI: 1114586302
Provider Name (Legal Business Name): KRISTIN LEE KALINOWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 05/27/2023
Certification Date: 05/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 2009B
SAINT LOUIS MO
63141-8265
US

IV. Provider business mailing address

522 N NEW BALLAS RD STE 300
SAINT LOUIS MO
63141-6840
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6062
  • Fax:
Mailing address:
  • Phone: 314-405-9556
  • Fax: 314-405-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2023012435
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: