Provider Demographics
NPI:1376395327
Name:HIRAN, TONY KASIDET (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:KASIDET
Last Name:HIRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KASIDET
Other - Middle Name:
Other - Last Name:HIRANNIRAMOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 3019B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8267
Mailing Address - Country:US
Mailing Address - Phone:314-509-5305
Mailing Address - Fax:314-251-4454
Practice Address - Street 1:621 S NEW BALLAS RD STE 3019B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8267
Practice Address - Country:US
Practice Address - Phone:314-509-5305
Practice Address - Fax:314-251-4454
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program