Provider Demographics
NPI:1508623372
Name:APELLIDO, KRISTOFER
Entity Type:Individual
Prefix:
First Name:KRISTOFER
Middle Name:
Last Name:APELLIDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:APELLIDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18 S KINGSHIGHWAY BLVD APT 3R
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1307
Mailing Address - Country:US
Mailing Address - Phone:516-507-4314
Mailing Address - Fax:
Practice Address - Street 1:18 S KINGSHIGHWAY BLVD APT 3R
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1307
Practice Address - Country:US
Practice Address - Phone:516-507-4314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program