Organization
SURGICAL DIAGNOSTICS & THERAPY LLC
Active
Other names
Kenneth J Bennett MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH J BENNETT MD (PRESIDENT)
(314) 569-2626
Entity
Organization
Contact information
Practice address
675 OLD BALLAS RD, STE 100A, SAINT LOUIS, MO 63141-7083
(314) 569-2626
(314) 569-1711
Mailing address
PO BOX 411220, SAINT LOUIS, MO 63141-1220
(314) 569-2626
(314) 569-1711
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
R4131
MO
Other
Enumeration date
11/07/2005
Last updated
11/01/2007
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