Provider Demographics
NPI:1598783938
Name:MANKOWITZ, KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:MANKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:STE 303
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:314-434-3278
Mailing Address - Fax:314-590-5949
Practice Address - Street 1:121 SAINT LUKES CENTER DR
Practice Address - Street 2:STE 303
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-434-3278
Practice Address - Fax:314-590-5949
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO101799207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1598783938Medicaid
MO832210183Medicaid
MO832210183Medicare PIN
MO832210183Medicaid
MOMA4523993Medicare PIN