Provider Demographics
NPI:1407982200
Name:PAIS, WILSON PRAKASH (MD)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:PRAKASH
Last Name:PAIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PLAZA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5148
Mailing Address - Country:US
Mailing Address - Phone:573-472-6010
Mailing Address - Fax:573-472-6009
Practice Address - Street 1:135 PLAZA DR STE 102
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5148
Practice Address - Country:US
Practice Address - Phone:573-472-6010
Practice Address - Fax:573-472-6009
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007012297207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1407982200OtherIL MCD
MO1407982200Medicaid
MO493716OtherCOVENTRY
MO493716OtherCOVENTRY
MO1407982200Medicaid