Provider Demographics
NPI:1568872901
Name:MWANTHI, MUITHI MWANGANGI (MD)
Entity type:Individual
Prefix:DR
First Name:MUITHI
Middle Name:MWANGANGI
Last Name:MWANTHI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-273-3376
Mailing Address - Fax:888-665-8309
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 502
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-273-3376
Practice Address - Fax:888-665-8309
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017778207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200060392Medicaid