Healthcare Provider Details

I. General information

NPI: 1265454987
Provider Name (Legal Business Name): KSENIJA KOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/07/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N NEW BALLAS CT DIV NEUROLOGY COMMUNITY, STE 202
SAINT LOUIS MO
63141-7134
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 557-747-2529
  • Fax: 314-371-4704
Mailing address:
  • Phone: 557-747-2529
  • Fax: 314-371-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2001010352
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: