Individual
KEITH WICKENHAUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
711 VETERANS MEMORIAL PKWY STE 300, SAINT CHARLES, MO 63303-2106
(636) 669-2350
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2018011071
MO
207R00000X
Internal Medicine Physician
R3656
KY
208000000X
Pediatrics Physician
2018011071
MO
Other
Enumeration date
03/31/2014
Last updated
09/03/2024
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