Individual
ANNE A. IDICULLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
802 N RIVERSIDE RD, SUITE 260, SAINT JOSEPH, MO 64507-9794
(816) 271-7673
(816) 271-4924
Mailing address
802 N RIVERSIDE RD, SUITE 130, SAINT JOSEPH, MO 64507-2502
(816) 271-7673
(816) 271-4924
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2001010866
MO
Other
Enumeration date
06/28/2006
Last updated
10/06/2017
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