Individual
MICHAEL K WOLVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3635 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 268-5783
(314) 268-5116
Mailing address
3691 RUTGER ST, PROVIDER ENROLLMENT, SAINT LOUIS, MO 63110-2515
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
R8237
MO
2085R0202X
Diagnostic Radiology Physician
Primary
R8237
MO
2085U0001X
Diagnostic Ultrasound Physician
R8237
MO
Other
Enumeration date
07/20/2006
Last updated
03/18/2008
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