Provider Demographics
NPI:1861658874
Name:MADAN, MAANASI (MBBS)
Entity Type:Individual
Prefix:
First Name:MAANASI
Middle Name:
Last Name:MADAN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-7800
Mailing Address - Fax:314-996-7829
Practice Address - Street 1:3009 N BALLAS RD STE 227A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2308
Practice Address - Country:US
Practice Address - Phone:314-996-7800
Practice Address - Fax:314-996-7829
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50283207R00000X, 208M00000X
MO2016009222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine