Individual
ILYA BUNIMOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 257-8000
Mailing address
WEST PAVILION, ROOM G120, 3655 VISTA AVENUE, ST. LOUIS, MO 63110-2602
(314) 257-8222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021013043
MO
363AM0700X
Medical Physician Assistant
2021013043
MO
Other
Enumeration date
07/29/2021
Last updated
10/28/2021
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