Individual
BASSAM MALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 BOWLES AVE STE 200, FENTON, MO 63026-2308
(636) 496-3900
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2014020140
MO
390200000X
Student in an Organized Health Care Education/Training Program
2010019819
MO
Other
Enumeration date
07/08/2010
Last updated
11/16/2020
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