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Individual

SELVARAJ MUTHUSAMY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.,

Contact information

Practice address
1325 S GRAND BLVD, ROOM 436, SAINT LOUIS, MO 63104-1018
(314) 577-8694
Mailing address
1325 S GRAND BLVD, ROOM 436, SAINT LOUIS, MO 63104-1018

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2014016506
MO

Other

Enumeration date
06/12/2014
Last updated
01/22/2018
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