Provider Demographics
NPI:1386040590
Name:RAO, RAVINDER SINGH
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:SINGH
Last Name:RAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:APT 15 G
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1378
Mailing Address - Country:US
Mailing Address - Phone:917-291-1757
Mailing Address - Fax:
Practice Address - Street 1:40 N KINGSHIGHWAY BLVD
Practice Address - Street 2:APT 15 G
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1378
Practice Address - Country:US
Practice Address - Phone:917-291-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-16
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027737207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease