Healthcare Provider Details

I. General information

NPI: 1689091878
Provider Name (Legal Business Name): MELANIE SCHWIESOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD STE 101
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD STE 101
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-4325
  • Fax:
Mailing address:
  • Phone: 314-525-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2023006666
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: