Individual
DR. WILLIS KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6810 STATE ROUTE 162 STE 102B, MARYVILLE, IL 62062-8560
(618) 288-4076
(618) 288-4215
Mailing address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(314) 448-3791
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT213475
PA
207RC0000X
Cardiovascular Disease Physician
MT213475
PA
207RI0011X
Interventional Cardiology Physician
Primary
036171090
IL
207RI0011X
Interventional Cardiology Physician
2024024174
MO
Other
Enumeration date
06/01/2017
Last updated
09/19/2025
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