Provider Demographics
NPI:1083670442
Name:KIMCHI, ERIC T (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:KIMCHI
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 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-882-8454
Mailing Address - Fax:573-884-6054
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-8908
Practice Address - Country:US
Practice Address - Phone:843-882-8454
Practice Address - Fax:573-884-6054
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027319208600000X, 2086X0206X
SC361152086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I39718Medicare UPIN
PA1013492010001Medicaid
PA1013492010001Medicaid