Provider Demographics
NPI:1275735458
Name:POELKER, CYNTHIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:J
Last Name:POELKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:225 CLARKSON RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2278
Mailing Address - Country:US
Mailing Address - Phone:636-230-5050
Mailing Address - Fax:636-230-5057
Practice Address - Street 1:225 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2278
Practice Address - Country:US
Practice Address - Phone:636-230-5050
Practice Address - Fax:636-230-5057
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO146890002Medicare PIN