Provider Demographics
NPI:1033124888
Name:KYRAMARIOS, CONSTANTINE
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:KYRAMARIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 CLARKSON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4976
Mailing Address - Country:US
Mailing Address - Phone:636-777-4500
Mailing Address - Fax:
Practice Address - Street 1:1726 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4976
Practice Address - Country:US
Practice Address - Phone:636-777-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005012033213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1033124888OtherNPI
MO258343560Medicare PIN