Provider Demographics
NPI:1508907247
Name:KLOSS, KURT (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:KLOSS
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 1:333 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2519
Mailing Address - Country:US
Mailing Address - Phone:314-249-5627
Mailing Address - Fax:314-962-3696
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-257-5879
Practice Address - Fax:618-257-6740
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088207207P00000X
MO2016009160207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930124097OtherRAILROAD MEDICARE
ILL93054Medicare ID - Type Unspecified