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General NPI Number Information
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NPI Number | 1720108350
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Entity Type | Organization
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Legal Business Name | CRESTWOOD AFFTON MEDICAL CENTER P C
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 533 COUCH AVE STE 281
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City | KIRKWOOD
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State | MO
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Zip | 63122-5561
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Country | US
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Telephone | 314-965-2322
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Fax |
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Provider Business Mailing Address
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Address Line | 533 COUCH AVE STE 281
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City | KIRKWOOD
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State | MO
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Zip | 63122-5561
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MILTON KARDESCH
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Credential |
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Telephone | 314-965-2322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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