Individual
KEVIN L SHADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
(314) 548-4748
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036088119
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006021895
BLUE
IL
05
—
0360881191
—
IL
01
—
1390
BLUE
MO
01
—
1609006
PH PLAN
—
01
—
18177
BLUER CHOICE
—
05
—
208893503
—
MO
01
—
251709
H LINK
—
01
—
2781
GHP
—
01
—
300066968
RR CARE
—
01
—
300066973
RR CARE
—
01
—
300066978
RR CARE
—
01
—
398004
HLT PART
—
01
—
431725842MID
MERCY
—
01
—
46068
HCARE USA
—
01
—
F70866
GATE WAY
—
Enumeration date
11/01/2006
Last updated
03/12/2024
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