Healthcare Provider Details

I. General information

NPI: 1003540394
Provider Name (Legal Business Name): MANAR SHMAIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 S SPRING AVE
SAINT LOUIS MO
63110-2520
US

IV. Provider business mailing address

1008 S SPRING AVE
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 507-271-8587
  • Fax: 314-977-1660
Mailing address:
  • Phone: 507-271-8587
  • Fax: 314-977-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number32359
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2023017628
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: