Individual
DR. KONRAD WIDMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 COVERLY LN, SAINT LOUIS, MO 63126-3200
(314) 933-0151
Mailing address
1 COVERLY LN, SAINT LOUIS, MO 63126-3200
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036048901
IL
Other
Enumeration date
07/18/2006
Last updated
06/26/2012
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