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Individual

KATRINA R WADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3635 VISTA AVE, WEST PAVILION, ROOM 315, SAINT LOUIS, MO 63110-2539
(314) 577-8776
(314) 268-5697
Mailing address
3691 RUTGER ST, PROVIDER ENROLLMENT, SAINT LOUIS, MO 63110-2515
(314) 977-6828
(314) 977-6777

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
114707
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
209268101
MO
01
P00273317
RR MEDICARE
MO
Enumeration date
10/06/2006
Last updated
01/22/2009
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