Provider Demographics
NPI:1124013487
Name:RAIKAR, SUDHIR R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:R
Last Name:RAIKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:920 BELLERIVE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6094
Mailing Address - Country:US
Mailing Address - Phone:314-434-6841
Mailing Address - Fax:
Practice Address - Street 1:83 PROGRESS PKWY
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3701
Practice Address - Country:US
Practice Address - Phone:314-434-8174
Practice Address - Fax:314-434-8706
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8500207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF08623Medicare UPIN