Provider Demographics
NPI:1508905183
Name:DEVKOTA, BISHNU P (MD)
Entity Type:Individual
Prefix:DR
First Name:BISHNU
Middle Name:P
Last Name:DEVKOTA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2325 DOUGHERTY FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3356
Mailing Address - Country:US
Mailing Address - Phone:314-977-9600
Mailing Address - Fax:314-977-9627
Practice Address - Street 1:3691 RUTGER ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2515
Practice Address - Country:US
Practice Address - Phone:314-977-6828
Practice Address - Fax:314-977-6777
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA15547R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1476056Medicaid
LA1476056Medicaid
LAG78848Medicare UPIN