Individual
KEVIN K PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
Mailing address
PO BOX 959354, SAINT LOUIS, MO 63195-1863
(618) 257-6220
(618) 257-6679
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036157104
IL
208M00000X
Hospitalist Physician
Primary
036157104
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2017
Last updated
09/18/2025
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