Healthcare Provider Details

I. General information

NPI: 1407982200
Provider Name (Legal Business Name): WILSON PRAKASH PAIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N MAIN ST
SIKESTON MO
63801-5046
US

IV. Provider business mailing address

1008 N MAIN ST
SIKESTON MO
63801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 573-621-4935
  • Fax: 573-258-8477
Mailing address:
  • Phone: 573-471-1600
  • Fax: 573-258-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2007012297
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: