Basic Information
| Provider Information | |||||||||
| NPI: | 1447213178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLESH | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18108 BENT RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | WILDWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630381435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364584177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 621 S NEW BALLAS RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142515860 | ||||||||
| FaxNumber: | 3142515861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | R8G17 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.