Mahoney, Kevin R

Mahoney, Kevin R is an individual health care provider with primary practice located at 1225 S Grand Blvd Level 2, Saint Louis MO 63104-1016. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Trauma Surgery. Allopathic & Osteopathic Physicians / Trauma Surgery is his primary health care specialty. Mahoney, Kevin R can be contacted via phone (314) 977-4440.

Contact Information

Primary practice address
1225 S Grand Blvd Level 2 Saint Louis MO 63104-1016
Phone: (314) 977-4440
Fax: (314) 977-1877
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 43940 Wisconsin
Allopathic & Osteopathic Physicians / Surgery 208600000X 43940 Wisconsin
Allopathic & Osteopathic Physicians / Trauma Surgery 2086S0127X 2007020558 Missouri

Profile Details

NPI number 1386745115
LBN Legal business name Mahoney, Kevin R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2006
Last updated Feb 8th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386745115 NPPES
Wisconsin MEDICAID 34148300
Wisconsin MEDICAID 208544213

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