Healthcare Provider Details

I. General information

NPI: 1841243888
Provider Name (Legal Business Name): CYNTHIA KARDESCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY ATTN: CREDENTIALING OFFICE
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax: 314-268-6468
Mailing address:
  • Phone: 314-989-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number100761
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: