Individual
DR. THOMAS PATRICK KUCIEJCZYK-KERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3930 S BROADWAY, SAINT LOUIS, MO 63118-4626
(314) 898-1700
(314) 814-8542
Mailing address
1717 BIDDLE ST, SAINT LOUIS, MO 63106-3454
(314) 898-1700
(314) 814-8542
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R6J90
MO
2084P0015X
Psychosomatic Medicine Physician
R6J90
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202710109
—
MO
Enumeration date
06/22/2005
Last updated
09/01/2016
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