Individual
KYLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12680 OLIVE BLVD STE 300, SAINT LOUIS, MO 63141-6322
(314) 251-8888
Mailing address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-8888
(314) 251-8889
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2017019521
MO
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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