Individual
SANDRA K. MINCHOW-PROFFITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
103 N TAYLOR AVE, STE C, KIRKWOOD, MO 63122-4360
(314) 380-4566
(314) 743-3700
Mailing address
103 N TAYLOR AVE, STE C, KIRKWOOD, MO 63122-4360
(314) 380-4566
(314) 743-3700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2004008255
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346215787
—
MO
01
—
P00179906
RAILROAD MEDICARE
MO
Enumeration date
02/21/2006
Last updated
05/23/2022
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