Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 2017043456 | MO |
NPI | 1750728192 |
---|---|
Provider Name | Dr. Malak Itani |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2013 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200051946 | (05) | MO |