Provider Demographics
NPI:1437109550
Name:BAGWE, MAHESH R (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:R
Last Name:BAGWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14825 N OUTER 40 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:314-336-2555
Mailing Address - Fax:844-894-6965
Practice Address - Street 1:14825 N OUTER 40 RD STE 200
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:314-336-2555
Practice Address - Fax:844-894-6965
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004015911207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO673385OtherHEALTHLINK
MO7275472OtherAETNA
MOP00209253OtherRAILROAD MEDICARE
MO0901688OtherUNITED HEALTHCARE
MO191945OtherBLUE CROSS BLUE SHIELD
MO222221OtherGROUP HEALTH PLAN
MO222221OtherGROUP HEALTH PLAN
MO222221OtherGROUP HEALTH PLAN