Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Vanisa Ezukuse, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1720880024

Vanisa Ezukuse, MD is a Student in an Organized Health Care Education/Training Program in Saint Louis, Missouri. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1201 S Grand Blvd
Saint Louis, MO 63104
Phone: (314) 257-8000
Fax: (314) 977-1664
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1720880024
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 26, 2025
Last updated in NPPESNovember 26, 2025
Certification dateNovember 26, 2025
Mailing address1402 South Grand Blvd, Saint Louis, MO 63104

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