Individual
DR. KEVIN LUKE KANALLAKAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6420 CLAYTON RD, RICHMOND HEIGHTS, MO 63117-1811
(314) 768-8000
Mailing address
78 DEPOT DR, GLEN CARBON, IL 62034-2755
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2018029592
MO
Other
Enumeration date
08/14/2018
Last updated
08/14/2018
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