Provider Demographics
NPI:1609280916
Name:PANNI, ROHEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROHEENA
Middle Name:
Last Name:PANNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-0410
Mailing Address - Fax:877-991-8954
Practice Address - Street 1:10 BARNES WEST DR
Practice Address - Street 2:DIV SURG HPB, STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6287
Practice Address - Country:US
Practice Address - Phone:314-747-0410
Practice Address - Fax:877-991-8954
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230151272086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200061315Medicaid