Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 2005012033 | MO |
Y | 222Z00000X | Podiatrist | 2005012033 | MO |
NPI | 1033124888 |
---|---|
Provider Name | Constantine Kyramarios |
First Address | Chesterfield, MO 63017-4976 |
Second Address | Chesterfield, MO 63017-4976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 23/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033124888 | NPI (01) | MO |