Individual
KENNETH ALLEN HACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6 JUNGERMANN CIRCLE, STE 205, ST PETERS, MO 63376
(636) 441-2122
(636) 441-5290
Mailing address
6 JUNGERMANN CIRCLE, STE 205, ST PETERS, MO 63376
(636) 441-2122
(636) 441-5290
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R5N50
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000487747642
MERCY
—
01
—
017069
EXCLUSIVE CHOICE
—
01
—
020029159
RAILROAD MEDICARE
—
01
—
088443
GREAT WEST
—
01
—
1053235
CARE PARTNER
—
01
—
11615
ESSENCE
—
01
—
1328V2907
GHP
—
01
—
1700152
UNITED HEALTHCARE
—
05
—
203711015
—
MO
01
—
209034
HEALTHLINK
—
01
—
29293
BLUE CHOICE
—
01
—
430910980007
PRUDENTIAL
—
01
—
4337092
AETNA
—
01
—
986C2
BLUE CROSS BLUE SHIELD
MO
01
—
BLC27144001
BLUE CHOICE
—
01
—
G1257A
PRINCIPAL
—
01
—
M6725
MEDICARE ARKANSAS
—
01
—
SP14388
CIGNA
—
Enumeration date
04/05/2006
Last updated
01/06/2022
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