Individual
ROBERT C. WANLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4600 MEMORIAL DR, SUITE 320, BELLEVILLE, IL 62226-5366
(618) 257-2100
(618) 257-2169
Mailing address
4600 MEMORIAL DR, SUITE 320, BELLEVILLE, IL 62226-5366
(618) 257-2100
(618) 257-2169
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036 - 052657
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052657
—
IL
Enumeration date
10/06/2005
Last updated
03/20/2014
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