Organization
ST. LOUIS THORACIC AND VASCULAR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL ROBERT KRAEGER M.D. (OWNER)
(314) 543-5939
Entity
Organization
Contact information
Practice address
10004 KENNERLY RD STE 186B, SAINT LOUIS, MO 63128-2176
(314) 543-5939
(314) 543-5954
Mailing address
10004 KENNERLY RD, SUTIE 186B, SAINT LOUIS, MO 63128-2141
(314) 543-5939
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
31077
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501942809
—
MO
Enumeration date
02/22/2007
Last updated
05/04/2009
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