Provider Demographics
NPI:1053338681
Name:PATEL, ANAND CHAMPAK (MD)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:CHAMPAK
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:C B 8116
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2694
Mailing Address - Fax:314-454-2515
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:STE C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2694
Practice Address - Fax:314-454-2515
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-01-17
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Provider Licenses
StateLicense IDTaxonomies
MO20050087712080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO103810034Medicaid
TN1516612Medicaid
IL150623313Medicaid
IL150623313Medicaid