1780637553 NPI number — KEVIN MICHAEL SCHARFF MD

Table of content: KEVIN MICHAEL SCHARFF MD (NPI 1780637553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780637553 NPI number — KEVIN MICHAEL SCHARFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHARFF
Provider First Name:
KEVIN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHARFF
Provider Other First Name:
K
Provider Other Middle Name:
MICHAEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780637553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 955534
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63195-5534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2246 ILLINOIS STATE ROUTE 157
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLEN CARBON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-288-9251
Provider Business Practice Location Address Fax Number:
618-288-6900
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  2016004839 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 036111603 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036111603 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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