Healthcare Provider Details

I. General information

NPI: 1134562937
Provider Name (Legal Business Name): MELISSA ANN WEHRMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD RM 2717 SSM CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD RM 2717 SSM CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax: 314-577-5616
Mailing address:
  • Phone: 314-577-5600
  • Fax: 314-577-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberDR.0058340
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016011494
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: