Provider Demographics
NPI:1962472480
Name:TEKWANI, SHAMLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMLAL
Middle Name:
Last Name:TEKWANI
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 1:3535 S JEFFERSON AVE STE S4
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3900
Mailing Address - Country:US
Mailing Address - Phone:314-771-3000
Mailing Address - Fax:314-771-4094
Practice Address - Street 1:3535 S JEFFERSON AVE STE S4
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3900
Practice Address - Country:US
Practice Address - Phone:314-771-3000
Practice Address - Fax:314-771-4094
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4D77207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202236360Medicaid
MO5154OtherBCBS OF MO
MO0347500001OtherD MERC
MO000001642OtherMEDICARE
MO000001642OtherMEDICARE