Provider Demographics
NPI:1114900867
Name:KROJANKER, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:KROJANKER
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 1:1066 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6340
Mailing Address - Country:US
Mailing Address - Phone:314-205-1707
Mailing Address - Fax:314-205-1733
Practice Address - Street 1:1066 EXECUTIVE PARKWAY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6340
Practice Address - Country:US
Practice Address - Phone:314-205-1707
Practice Address - Fax:314-205-1733
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9F182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202890414Medicaid
MO8829Medicare ID - Type UnspecifiedMEDICARE
MO202890414Medicaid