Provider Demographics
NPI:1124011028
Name:CHOUHAN, LALITHKUMAR K (MD)
Entity Type:Individual
Prefix:DR
First Name:LALITHKUMAR
Middle Name:K
Last Name:CHOUHAN
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 1:11125 DUNN RD
Mailing Address - Street 2:STE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-839-5522
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:STE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-839-5522
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073350207RC0000X
MOR2E98207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
6287491OtherCIGNA
MO006029924OtherMORRMCR
5567V8816OtherHCUSA
229043OtherHLNK
2500129OtherUHC
MO27698OtherMOBS/BLCHOICE
F18347OtherMERCY
000000012519OtherESSENCE
IL060067892OtherILRRMCR
MO203348701Medicaid
431098908OtherTRICARE
1455V3831OtherGHP/CMR
4379428OtherAETNA
MO203348701Medicaid
ILL86365Medicare PIN
MO099050163Medicare PIN
000000012519OtherESSENCE
1455V3831OtherGHP/CMR
ILL87310Medicare PIN
MO005013908Medicare PIN