Provider Demographics
NPI:1467465443
Name:LEVY, KENNETH CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:226 S WOODS MILL RD
Mailing Address - Street 2:STE 36W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3662
Mailing Address - Country:US
Mailing Address - Phone:314-453-9666
Mailing Address - Fax:314-453-9895
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:STE 36W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-453-9666
Practice Address - Fax:314-453-9895
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-11-29
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Provider Licenses
StateLicense IDTaxonomies
MOR1P16208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209867902Medicaid