MEDICARE: KEITH R THOMAE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2010011996	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184679409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH R THOMAE M.D.

Provider Business Mailing Address
First Line	:	3331 W DEYOUNG ST
Second Line	:	STE 305
City	:	MARION
State	:	IL
Zip	:	62959-5898
Country	:	US
Telephone Number	:	314-838-6600
Fax Number	:	314-838-6611

Provider Business Practice Location Address
First Line	:	3533 DUNN RD
Second Line	:	SUITE 210
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6761
Country	:	US
Telephone Number	:	314-838-6600
Fax Number	:	314-838-6611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	02/22/2017

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