Individual
KEVIN R MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1225 S GRAND BLVD, LEVEL 2, SAINT LOUIS, MO 63104-1016
(314) 977-4440
(314) 977-1877
Mailing address
1008 S SPRING AVE STE 1615, SAINT LOUIS, MO 63110-2520
(314) 977-4717
(314) 977-1877
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
43940
WI
208600000X
Surgery Physician
43940
WI
2086S0127X
Trauma Surgery Physician
Primary
2007020558
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208544213
—
MO
05
—
34148300
—
WI
Enumeration date
09/26/2006
Last updated
09/22/2025
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