Provider Demographics
NPI:1184821423
Name:KARANDISH, ERIN (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KARANDISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRENTMOOR PARK
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3066
Mailing Address - Country:US
Mailing Address - Phone:314-289-6434
Mailing Address - Fax:
Practice Address - Street 1:915 NORTH GRAND AVENUE
Practice Address - Street 2:VA MEDICAL CENTER, DIVISION OF GASTROENTEROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106
Practice Address - Country:US
Practice Address - Phone:314-289-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006011974390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program