Healthcare Provider Details

I. General information

NPI: 1558317461
Provider Name (Legal Business Name): BETH K LEVY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. BETH KESSLER

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 PIPER HILL DR STE 12
SAINT PETERS MO
63376-1690
US

IV. Provider business mailing address

112 PIPER HILL DR STE 12
SAINT PETERS MO
63376-1690
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-4205
  • Fax: 636-244-4209
Mailing address:
  • Phone: 636-244-4205
  • Fax: 636-244-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberR2G62
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: