Individual
DR. KELLY EILEEN MCDERMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4921 PARKVIEW PL, DIV IM GENERAL MED, STE 12B, SAINT LOUIS, MO 63110-1032
(314) 747-3969
(314) 996-3230
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 747-3969
(314) 996-3230
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2023001041
MO
208D00000X
General Practice Physician
Primary
2023001041
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200085095
—
MO
Enumeration date
06/19/2020
Last updated
04/17/2025
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