Provider Demographics
NPI:1427035955
Name:PADDA, GURPREET (MD)
Entity Type:Individual
Prefix:MR
First Name:GURPREET
Middle Name:
Last Name:PADDA
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 1:5203 CHIPPEWA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2356
Mailing Address - Country:US
Mailing Address - Phone:314-481-5000
Mailing Address - Fax:
Practice Address - Street 1:5203 CHIPPEWA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2356
Practice Address - Country:US
Practice Address - Phone:314-481-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1005722081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO118505OtherGHP
MO4647144OtherAETNA
MO149848OtherBLUE CROSS BLUE SHILED
MO7200000096OtherMEDICARE RAIL ROAD
MO175746OtherHELATH LINK
MO2001272OtherUHC
MO001013516Medicare PIN
MO2001272OtherUHC