Provider Demographics
NPI:1427267459
Name:KEVIN T ENGER MD PC
Entity type:Organization
Organization Name:KEVIN T ENGER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:636-931-5080
Mailing Address - Street 1:1400 US HIGHWAY 61
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-931-5080
Mailing Address - Fax:
Practice Address - Street 1:1400 US HWY 61
Practice Address - Street 2:SUITE 310
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-931-5080
Practice Address - Fax:636-937-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209004209Medicaid
MOH75871Medicare UPIN
MO000013803Medicare ID - Type Unspecified
MODB6812Medicare PIN