Individual
WENDOLYN M DISALVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11133 DUNN RD, STREET, SAINT LOUIS, MO 63136-6119
(314) 653-5000
Mailing address
75 REMIT DR, LOCKBOX 6810, CHICAGO, IL 60675-6810
(866) 916-5259
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2003014836
MO
207P00000X
Emergency Medicine Physician
2006032134
MO
208000000X
Pediatrics Physician
Primary
2006032134
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202437901
—
MO
Enumeration date
11/24/2006
Last updated
03/15/2023
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