Provider Demographics
NPI:1073546107
Name:BAJAJ, MADHU SATYA (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:SATYA
Last Name:BAJAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADHU
Other - Middle Name:SATYA
Other - Last Name:BAJAJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 CITYPLACE DR STE 570
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7067
Mailing Address - Country:US
Mailing Address - Phone:866-394-6100
Mailing Address - Fax:
Practice Address - Street 1:1 CITYPLACE DR STE 570
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:866-394-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42630207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A426300Medicaid
CA00A426300Medicaid