Provider Demographics
NPI:1093732737
Name:LUTHER, RAJESHWAR K (MD)
Entity Type:Individual
Prefix:
First Name:RAJESHWAR
Middle Name:K
Last Name:LUTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411515
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-3515
Mailing Address - Country:US
Mailing Address - Phone:314-333-6750
Mailing Address - Fax:314-432-0178
Practice Address - Street 1:11615 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7095
Practice Address - Country:US
Practice Address - Phone:314-993-9555
Practice Address - Fax:314-432-0178
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO359052085R0202X
IL0360595422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201369220Medicaid
MO300102479OtherRAILROAD MEDICARE
MO300102468OtherRAILROAD MEDICARE
IL300105149OtherRAILROAD MEDICARE
IL300105149OtherRAILROAD MEDICARE
ILL72555Medicare ID - Type UnspecifiedIL MEDICARE
MO201369220Medicaid
A09915Medicare UPIN