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Individual

MR. KEVIN A NETTESHEIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
4305 BUTLER HILL RD STE B, SAINT LOUIS, MO 63128-3718
(314) 849-9009
(314) 849-9004
Mailing address
4305 BUTLER HILL RD STE B, SAINT LOUIS, MO 63128-3718
(314) 849-9009
(314) 849-9004

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000531
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
104946-003
BLUE CROSS/BLUE SHIELD
MO
01
107843
HEALTHLINK
MO
05
308054006
MO
01
4443980001
DMERC/CIGNA
MO
01
480033520
RAILROAD MEDICARE
MO
Enumeration date
05/23/2005
Last updated
04/28/2015
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