Healthcare Provider Details

I. General information

NPI: 1639014541
Provider Name (Legal Business Name): VAX CONCIERGE MO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 AMHERST AVE
UNIVERSITY CITY MO
63130-3605
US

IV. Provider business mailing address

8150 AMHERST AVE
UNIVERSITY CITY MO
63130-3605
US

V. Phone/Fax

Practice location:
  • Phone: 773-260-0964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDAH KANOWITZ
Title or Position: OWNER
Credential:
Phone: 773-260-0964