Provider Demographics
NPI:1184757072
Name:DESILVA MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:DESILVA MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-731-5555
Mailing Address - Street 1:6308 HAZELWEST CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1739
Mailing Address - Country:US
Mailing Address - Phone:314-731-5555
Mailing Address - Fax:314-731-5558
Practice Address - Street 1:6308 HAZELWEST CT
Practice Address - Street 2:SUITE 200
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1739
Practice Address - Country:US
Practice Address - Phone:314-731-5555
Practice Address - Fax:314-731-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9845207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty