Provider Demographics
NPI:1811915549
Name:KENZORA, JOSEPH L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:KENZORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8086
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-6383
Mailing Address - Fax:314-747-1417
Practice Address - Street 1:4921 PARKVIEW PL STE 8A
Practice Address - Street 2:STE 8A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-6383
Practice Address - Fax:314-747-1417
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3B60207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202502407Medicaid
ILENROLLEDMedicaid
MO202502407Medicaid
MO060020644Medicare PIN
IL$$$$$$$$$Medicaid