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General NPI Number Information
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NPI Number | 1245475482
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Entity Type | Organization
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Legal Business Name | DR RAFI KEVORKIAN LLC
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 3760 S LINDBERGH BLVD SUITE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1358
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Country | US
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Telephone | 636-634-5865
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Fax | 314-849-5716
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Provider Business Mailing Address
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Address Line | 3760 S LINDBERGH BLVD SUITE 101
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1358
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Country | US
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Telephone | 636-634-5865
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Fax | 314-849-5716
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAFI T KEVORKIAN
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Credential | MD
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Telephone | 636-634-5865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 108134
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License Number State | MO
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