Provider Demographics
NPI:1336167030
Name:HRUSKA, KEITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:HRUSKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6043
Mailing Address - Fax:888-463-6898
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED NEPHROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6043
Practice Address - Fax:888-463-6898
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4380208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200943017Medicaid
IL0300669025Medicaid
KY7100091440Medicaid
MO009012057Medicare PIN
MO285010381Medicare PIN
MO285010381Medicaid
MO390002659Medicare PIN