Individual
MR. ANTOINE M ADEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
413 WYTHE HOUSE CT, SAINT LOUIS, MO 63141-8179
(636) 931-7101
(636) 933-2383
Mailing address
PO BOX 504835, ST. LOUIS, MO 63150-4835
(636) 931-7101
(636) 933-2383
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2024016604
MO
207RC0000X
Cardiovascular Disease Physician
Primary
2024016604
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205889926
—
MO
05
—
507493401
—
MO
01
—
P00258467
RR MEDICARE
MO
Enumeration date
06/02/2006
Last updated
12/12/2024
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