Provider Demographics
NPI:1043612773
Name:DEWAN, BRAHAM DEV (MD)
Entity Type:Individual
Prefix:MR
First Name:BRAHAM
Middle Name:DEV
Last Name:DEWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9917 GRANDVIEW FOREST COURT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-0046
Mailing Address - Country:US
Mailing Address - Phone:618-530-8494
Mailing Address - Fax:314-729-1234
Practice Address - Street 1:9917 GRANDVIEW FOREST COURT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:618-530-8494
Practice Address - Fax:314-729-1234
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.061466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine