KEITH WICKENHAUSER (NPI# 1184042855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184042855 |
| Entity Type | Individual |
| Full Name | KEITH WICKENHAUSER |
| Credential | MD |
| Practice Address |
201 Bjc Saint Peters Dr Ste 100 Saint Peters MO 63376 |
| Mailing Address |
201 Bjc Saint Peters Dr Ste 100 Saint Peters MO 63376-3386 |
| Practice Telephone | 6369168200 |
| Practice Fax Number | 6369465774 |
| Mailing Telephone | 6369168200 |
| Mailing Fax Number | 6369168239 |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-07-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 2018011071 | MO | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | R3656 | KY | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 550 S Jackson St, Suite A3k00, Louisville, KY 40202 | 5028524277 | 5028528980 |
| 201 Bjc Saint Peters Dr Ste 100, Saint Peters, MO 63376 | 6369168200 | 6369465774 |
| Street Address |
201 BJC SAINT PETERS DR STE 100 |
| City | SAINT PETERS |
| State | MO |
| Zip Code | 63376 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598146557 | Courtney Champagne Crider | Dermatology | 201 Bjc Saint Peters Dr Ste 100, Saint Peters, MO 63376-3386 | 2015-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275047946 | Nicholas Christian Schultz | Dentist | 100 Piper Hill Dr Ste A, Saint Peters, MO 63376 | 2017-11-16 |
| 1982120093 | Carol Weber | Speech-Language Pathologist | 166 Boone Hills Dr., St Peters, MO 63376 | 2017-08-21 |
| 1619424744 | Forefront Dermatology, S.c. | Dermatology | 5700 Mexico Rd, Suite 14, Saint Peters, MO 63376 | 2016-09-07 |
| 1508310632 | Preferred Family Healthcare, Inc. | Counselor | 2120 Parkway Dr, Saint Peters, MO 63376 | 2016-08-05 |
| 1598130676 | Delta Center Personal Attendant Services | In Home Supportive Care | 3833 Mcclay, Suite 61, St. Peters, MO 63376 | 2015-12-01 |
| 1427420314 | Barbara Marlene Edelman | Counselor | 1286 Jungerman Rd. Suite G, St. Peters, MO 63376 | 2015-10-30 |
| 1255740247 | Claire Williams | Dentist | 340 Mid Rivers Mall Drive, Suite E, St. Peters, MO 63376 | 2014-08-05 |
| 1821415233 | Abby Link | Physician Assistant | 107 Piper Parkway, #150, St. Peters, MO 63376 | 2014-03-24 |
| 1225452105 | Ashley Gagel | Physical Therapist | 7055 Mexico Rd Suite 1601, St. Peters, MO 63376 | 2014-02-12 |
| 1083052591 | Sarah Linn | Social Worker | 1236 Jungermann Rd Ste D, Saint Peters, MO 63376 | 2013-06-06 |
| Find all providers in zip 63376 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699385757 | Mark Steven Routburg | Internal Medicine | 509 Sgt Pepper Dr, Saint Peters, MO 63376-2441 | 2020-08-04 |
| 1124164066 | Sandeep Hindupur | Internal Medicine | 10 Hospital Dr Ste 100, Saint Peters, MO 63376-1659 | 2007-01-29 |
| 1013973213 | Furqan F Raja | Internal Medicine | 70 Jungermann Circle, Suite 405, Saint Peters, MO 63376 | 2006-04-25 |
| 1275502049 | Timothy R. Smith | Internal Medicine | 3862 Mexico Rd, Saint Peters, MO 63303-3041 | 2006-03-15 |
| 1578531299 | Henrikas Irmantas Juknis | Internal Medicine | 6 Jungermann Cir Ste 215, Saint Peters, MO 63376-1626 | 2006-03-09 |
| 1356349609 | Kurt A Piening | Internal Medicine | 201 Bjc Saint Peters Dr, Suite 100, Saint Peters, MO 63376-3091 | 2005-07-11 |
| 1548730294 | Laura Raley | Internal Medicine | 408 Jungermann Rd, Saint Peters, MO 63376-2799 | 2018-11-26 |
| 1619483294 | Heritage Wellness Clinic LLC | Internal Medicine | 2730 S Saint Peters Pkwy, Saint Peters, MO 63303-5677 | 2017-12-19 |
| 1013310788 | Medical Essentials LLC | Internal Medicine | 2730 S Saint Peters Pkwy, Suite 203, Saint Peters, MO 63303-5677 | 2014-10-08 |
| 1790109247 | Prajakta Mungikar | Internal Medicine | 201 Bjc Saint Peters Dr Ste 200, Saint Peters, MO 63376 | 2014-02-04 |
| Find all providers in SAINT PETERS | ||||
| City | SAINT PETERS |
| Zip Code | 63376 |
Please comment or provide details below to improve the information on KEITH WICKENHAUSER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.