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General NPI Number Information
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NPI Number | 1700976347
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Entity Type | Individual
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Provider Name | KEITH A KRONEMER MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 29 LAKE FOREST DR
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1304
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Country | US
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Telephone | 314-498-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 29 LAKE FOREST DR
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1304
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Country | US
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Telephone | 314-498-0640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 100078
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 46837
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License Number State | KY
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