Provider Demographics
NPI:1689755209
Name:ALLAN E. KOLKER, M.D. LLC.
Entity Type:Organization
Organization Name:ALLAN E. KOLKER, M.D. LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-878-7962
Mailing Address - Street 1:12601 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6313
Mailing Address - Country:US
Mailing Address - Phone:314-878-7962
Mailing Address - Fax:314-878-7747
Practice Address - Street 1:12601 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6313
Practice Address - Country:US
Practice Address - Phone:314-878-7962
Practice Address - Fax:314-878-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA12161Medicare UPIN