Provider Demographics
NPI:1437173119
Name:VARDI, GIL M (MD)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:M
Last Name:VARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11155 DUNN RD
Mailing Address - Street 2:STE 304E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6150
Mailing Address - Country:US
Mailing Address - Phone:314-741-0911
Mailing Address - Fax:314-741-0501
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:STE 304E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-741-0911
Practice Address - Fax:314-741-0501
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO115324207RC0000X, 207RI0011X
IL036087043207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208326116Medicaid
IL36100225Medicaid
F08282Medicare UPIN