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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL STEPHEN HUNCHAREK M.D. (OWNER)
(314) 720-0855
Entity
Organization

Contact information

Practice address
1409 WASHINGTON AVE, SUITE 202, SAINT LOUIS, MO 63103-1936
(314) 620-4415
Mailing address
1409 WASHINGTON AVE, SUITE 202, SAINT LOUIS, MO 63103-1936
(314) 620-4415

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2011035207
MO

Other

Enumeration date
07/19/2013
Last updated
11/01/2013
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