MEDICARE: KATHRYN MARIE SHOEMAKER MD

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	207R00000X	Internal Medicine Physician	2017014174	MO

General Provider Information

NPI Number	:	1215347133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MARIE SHOEMAKER MD

Provider Business Mailing Address
First Line	:	9180 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1421
Country	:	US
Telephone Number	:	314-372-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	9180 W FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-1421
Country	:	US
Telephone Number	:	314-372-3420
Fax Number	:

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

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	03/07/2023

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