Provider Demographics
NPI:1760522916
Name:KAMAT, VINAY GOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:GOPAL
Last Name:KAMAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N MASON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6361
Mailing Address - Country:US
Mailing Address - Phone:314-758-6053
Mailing Address - Fax:
Practice Address - Street 1:1040 N MASON RD STE 102
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6361
Practice Address - Country:US
Practice Address - Phone:314-758-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003023595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO143240OtherBCBS-MO PROVIDER NO
MO388866OtherHEALTHLINK PROVIDER NO
MO501235006Medicaid
IL036098468OtherIL MEDICAID PROVIDER NO
MO143240OtherBCBS-MO PROVIDER NO
MOH04943Medicare UPIN