Provider Demographics
NPI:1366448722
Name:PATNANA, VIJAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:K
Last Name:PATNANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:351 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-200-4242
Mailing Address - Fax:636-200-4243
Practice Address - Street 1:17050 BAXTER RD
Practice Address - Street 2:SUITE #110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1422
Practice Address - Country:US
Practice Address - Phone:636-200-4242
Practice Address - Fax:636-200-4243
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2001019664207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH41508Medicare UPIN