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1104873116
ASHOK R MALLYA
SAINT LOUIS, MO
NPI
1104873116
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2084A0401X Psychiatry & Neurology, Addiction Medicine
(Licence: MO R6991)
Enumeration Date
2006-05-27
Last Update Date
2007-07-08
Business Address
-- ASHOK R MALLYA MD
915 N GRAND BLVD
SAINT LOUIS, MO 63106-1621
Phone number: 314-652-4100
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Mailing Address
-- ASHOK R MALLYA MD
12515 WINDMOOR PL
SAINT LOUIS, MO 63131-3019
Phone number: 314-652-4100
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