Provider Demographics
NPI:1942290044
Name:KRAFT, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:KRAFT
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 1:1150 GRAHAM RD
Mailing Address - Street 2:STE 107
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8077
Mailing Address - Country:US
Mailing Address - Phone:314-837-3667
Mailing Address - Fax:314-837-3728
Practice Address - Street 1:1150 GRAHAM RD
Practice Address - Street 2:STE 107
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8077
Practice Address - Country:US
Practice Address - Phone:314-837-3667
Practice Address - Fax:314-837-3728
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1PO1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO132586OtherBLUE CROSS BLUE SHIELD
MO132586OtherANTHEM BLUE SHIELD
MO208670323Medicaid
MO180046484OtherRAILROAD MEDICARE
MO1820046484OtherRAILROAD MEDICARE