Provider Demographics
NPI:1386642320
Name:RANA, SAMEER (MD)
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:RANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6336
Mailing Address - Country:US
Mailing Address - Phone:314-514-6000
Mailing Address - Fax:314-514-6020
Practice Address - Street 1:12303 DEPAUL DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-6000
Practice Address - Fax:314-514-6020
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008004925207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1386642320Medicaid
IA35909OtherMEDICAL LICENSE NUMBER
IA35909OtherMEDICAL LICENSE NUMBER
MN810000101Medicare ID - Type Unspecified