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Individual

WISSAM KIWAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1008 S SPRING AVE FL 2, SAINT LOUIS, MO 63110-2520
(313) 858-4090
Mailing address
1008 S SPRING AVE FL 2, SAINT LOUIS, MO 63110-2520
(313) 858-4090
(470) 232-1004

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
036164478
IL
207RG0100X
Gastroenterology Physician
Primary
2022010699
MO

Other

Enumeration date
05/29/2015
Last updated
03/13/2024
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