Individual
DR. JONATHAN W HEUSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4320 FOREST PARK AVE, STE 209, SAINT LOUIS, MO 63108-2979
(314) 362-5641
(314) 362-0369
Mailing address
660 S EUCLID AVE, CB 8118, SAINT LOUIS, MO 63110-1010
(314) 362-5641
(314) 362-0369
Taxonomy
Speciality
Code
Description
License number
State
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
Primary
108616
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043414113
—
MO
Enumeration date
10/06/2005
Last updated
11/15/2021
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