Provider Demographics
NPI:1023278785
Name:THOMAS J. KIRISITS, D.P.M., P.C.
Entity type:Organization
Organization Name:THOMAS J. KIRISITS, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KIRISITS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-644-6663
Mailing Address - Street 1:1027 BELLEVUE AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1851
Mailing Address - Country:US
Mailing Address - Phone:314-644-6663
Mailing Address - Fax:314-644-1354
Practice Address - Street 1:1027 BELLEVUE AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1851
Practice Address - Country:US
Practice Address - Phone:314-644-6663
Practice Address - Fax:314-644-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000547213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL372610Medicare PIN
MO000021197Medicare PIN
MOT42814Medicare UPIN