Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 2006012797 | MO |
NPI | 1053323915 |
---|---|
Provider Name | Dr. Kurt M Eichholz |
First Address | Saint Louis, MO 63127-1832 |
Second Address | Saint Louis, MO 63127-1832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BE9829790 | DEA (01) |