Provider Demographics
NPI:1699856443
Name:PANIAGUA, MIGUEL ANGEL (MD/MPH)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:PANIAGUA
Suffix:
Gender:M
Credentials:MD/MPH
Other - Prefix:DR
Other - First Name:MIGUEL
Other - Middle Name:ANGEL
Other - Last Name:PANIAGUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD/ MPH
Mailing Address - Street 1:1532 FOUNTAINHEAD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-3339
Mailing Address - Country:US
Mailing Address - Phone:314-355-3873
Mailing Address - Fax:314-355-7383
Practice Address - Street 1:12414 LUSHER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1456
Practice Address - Country:US
Practice Address - Phone:314-741-2500
Practice Address - Fax:314-741-0880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046269207RC0000X
MOR4B44207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO370983349OtherPANIAGUA MEDICAL LTD
MO192033OtherBCBSMO
MO125391OtherPHCS
MO5709126OtherAETNA
MOD04066OtherEXCLUSIVE CHOICE
MO000004790Medicare PIN
MO192033OtherBCBSMO