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NPI Code Detail

MEDICARE: JEFFREY H KIVIAT M.D.

MEDICARE: JEFFREY H KIVIAT 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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100723OTHERHEALTHLINK
24000541OTHERAETNA
331740OTHERGHP
445307OTHERGHP

General Provider Information

NPI Number : 1205810454
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY H KIVIAT M.D.
Provider Business Mailing Address
First Line : PO BOX 952009
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-2009
Country : US
Telephone Number : 314-821-8055
Fax Number : 314-821-1833
Provider Business Practice Location Address
First Line : 1 MEMORIAL DR
Second Line :
City : ALTON
State : IL
Zip : 62002-6722
Country : US
Telephone Number : 618-463-7410
Fax Number : 618-463-7641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 07/08/2007

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