Healthcare Provider Details

I. General information

NPI: 1558095059
Provider Name (Legal Business Name): KIERAN PAUL MCCARTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 06/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST LOUIS UNIVERSITY SCHOOL OF MEDICINE OFFICE OF GRADUATE MEDICAL EDUCATION
ST LOUIS MO
63104-6310
US

IV. Provider business mailing address

18 S KINGSHIGHWAY BLVD APT 12S
SAINT LOUIS MO
63108-1330
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4800
  • Fax:
Mailing address:
  • Phone: 314-459-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: