Individual
OMAR MUDALLAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036147331
IL
Other
Enumeration date
09/30/2012
Last updated
04/02/2024
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