Individual
BRADY AUGUSTUS WAHLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(801) 528-2214
Mailing address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2025019940
MO
Other
Enumeration date
04/11/2025
Last updated
06/09/2025
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