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NPI Code Detail

MEDICARE: KEVIN DANIEL THOMAS DO

MEDICARE: KEVIN DANIEL THOMAS DO
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
1207QS0010XSports Medicine (Family Medicine) Physician2025037410MO
2207Q00000XFamily Medicine Physician2025037410MO

General Provider Information

NPI Number : 1457937906
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN DANIEL THOMAS DO
Provider Business Mailing Address
First Line : 1225 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1016
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1225 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1016
Country : US
Telephone Number : 314-617-3431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2021
Last Update Date : 12/02/2025

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Directions to “ KEVIN DANIEL THOMAS DO” Practice Location

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