Dr Kevin M Ponciroli, MD is a
Pediatrics physician based in O Fallon, Illinois. Dr Kevin M Ponciroli is licensed to practice in Illinois (license number 036115733) and his current practice location is 793 Sunset Blvd, O Fallon, Illinois. He can be reached at his office (for appointments etc.) via phone at
(618) 668-2473.
NPI number for Dr Kevin M Ponciroli is 1598776411 and his current mailing address is 793 Sunset Blvd, O Fallon, Illinois. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1598776411.
Physician's Profile
Full Name | Dr Kevin M Ponciroli |
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Gender | Male |
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Speciality | Pediatrics |
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Location | 793 Sunset Blvd, O Fallon, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1598776411
- Provider Enumeration Date: 08/10/2006
- Last Update Date: 03/02/2021
Medical Identifiers
Medical identifiers for Dr Kevin M Ponciroli such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1598776411 | NPI | - | NPPES |
036115733 | Medicaid | IL | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208000000X | Pediatrics | 036115733 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kevin M Ponciroli is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Kevin M Ponciroli, MD 793 Sunset Blvd, O Fallon, IL 62269-1960 Ph: (618) 668-2473 | Dr Kevin M Ponciroli, MD 793 Sunset Blvd, O Fallon, IL 62269-1960 Ph: (618) 668-2473 |
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