Organization
GOMELB VASCULAR LLC
Active
Other names
Midwest Institute for Non-surgical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
OLAGUOKE AKINWANDE MD (PROVIDER)
(410) 499-1078
Entity
Organization
Contact information
Practice address
12855 N 40 DR STE 205, SAINT LOUIS, MO 63141-8670
(314) 255-2204
(866) 623-8346
Mailing address
12855 N 40 DR STE 205, SAINT LOUIS, MO 63141-8670
(314) 255-2204
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
246XC2903X
Vascular Specialist/Technologist Cardiovascular
Primary
2016010164
MO
2471C1101X
Cardiovascular-Interventional Technology Radiologic Technologist
201610164
MO
2471N0900X
Nuclear Medicine Technology Radiologic Technologist
2016010164
MO
2471V0106X
Vascular-Interventional Technology Radiologic Technologist
2016010164
MO
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
08/29/2018
Last updated
12/13/2022
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