Provider Demographics
NPI:1659478345
Name:AGNIHOTRI, VIVEK (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:AGNIHOTRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12401 OLIVE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5448
Mailing Address - Country:US
Mailing Address - Phone:314-627-1399
Mailing Address - Fax:314-380-2417
Practice Address - Street 1:12401 OLIVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5448
Practice Address - Country:US
Practice Address - Phone:314-627-1399
Practice Address - Fax:314-380-2417
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20090034112084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry