Provider Demographics
NPI:1336127208
Name:METRO FOOT SPECIALISTS LLC
Entity Type:Organization
Organization Name:METRO FOOT SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM, FACFAS
Authorized Official - Prefix:DR
Authorized Official - First Name:KRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOZLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,
Authorized Official - Phone:636-938-5006
Mailing Address - Street 1:62 E NORTH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1205
Mailing Address - Country:US
Mailing Address - Phone:636-938-5006
Mailing Address - Fax:636-587-3774
Practice Address - Street 1:521 N VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1115
Practice Address - Country:US
Practice Address - Phone:636-938-5006
Practice Address - Fax:636-587-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO367346509Medicaid
MO367176203Medicaid
MO5354160001Medicare NSC
MO000014527Medicare PIN