Provider Demographics
NPI:1629459045
Name:KIRCHHOFF, SARAH NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:KIRCHHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NICOLE
Other - Last Name:KAPLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:MA303, DC032.00
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-884-2912
Mailing Address - Fax:573-884-4122
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-8335
Practice Address - Country:US
Practice Address - Phone:660-463-7966
Practice Address - Fax:660-463-7729
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200029995Medicaid