Provider Demographics
NPI:1528067154
Name:KITCHIN, WINSTON (MD)
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:KITCHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13065 OLD TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3441
Mailing Address - Country:US
Mailing Address - Phone:314-843-4333
Mailing Address - Fax:314-843-4856
Practice Address - Street 1:4200 CLOVERLEAF DRIVE
Practice Address - Street 2:SUITE J-K
Practice Address - City:ST.PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-928-5109
Practice Address - Fax:636-447-4678
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:2005-07-18
Deactivation Code:
Reactivation Date:2005-07-19
Provider Licenses
StateLicense IDTaxonomies
MOR6H472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA29254Medicare UPIN