Dr Christopher Robert Wangard, MD | |
6800 State Route 162, Maryville, IL 62062-8521 | |
(618) 288-5711 | |
Not Available |
Full Name | Dr Christopher Robert Wangard |
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Gender | Male |
Speciality | Pediatrics |
Location | 6800 State Route 162, Maryville, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1023127396 | NPI | - | NPPES |
036101921 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 036101921 (Illinois) | Primary |
208000000X | Pediatrics | 112664 (Missouri) | Secondary |
Entity Name | Ssm Health Care St Louis |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1275586174 PECOS PAC ID: 7810800737 Enrollment ID: O20031118000393 |
Entity Name | Ssm Cardinal Glennon Children's Hospital |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1174577670 PECOS PAC ID: 7012828163 Enrollment ID: O20031231000604 |
Mailing Address | Practice Location Address |
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Dr Christopher Robert Wangard, MD 4165 Flora Pl, Saint Louis, MO 63110-3605 Ph: (618) 304-4375 | Dr Christopher Robert Wangard, MD 6800 State Route 162, Maryville, IL 62062-8521 Ph: (618) 288-5711 |
Dr. Jennifer Anne Loethen, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 5 Professional Park Dr, Maryville, IL 62062 Phone: 618-876-2924 | |
Dr. Jennifer Dawn Krick, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 6828 State Route 162, Maryville, IL 62062 Phone: 618-288-5084 Fax: 618-288-8045 |