MEDICARE: KARA CARDINAL PA

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	363A00000X	Physician Assistant	2006031529	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01362130	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1074081	OTHER	MO	NCCPA CERTIFICATION

General Provider Information

NPI Number	:	1619065331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA CARDINAL PA

Provider Business Mailing Address
First Line	:	701 S NEW BALLAS RD STE 330
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8702
Country	:	US
Telephone Number	:	314-251-8850
Fax Number	:	314-569-3846

Provider Business Practice Location Address
First Line	:	701 S NEW BALLAS RD STE 330
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8702
Country	:	US
Telephone Number	:	314-251-8850
Fax Number	:	314-569-3846

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/06/2023

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1508549361 — ANDREW TANOUS
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1902687254 — DANIEL DOERING RPH
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Directions to “ KARA CARDINAL PA” Practice Location

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