Provider Demographics
NPI:1467763607
Name:WALIA, SANDEEP KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:KUMAR
Last Name:WALIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8512
Mailing Address - Country:US
Mailing Address - Phone:314-448-3791
Mailing Address - Fax:314-996-7658
Practice Address - Street 1:4550 MEMORIAL DR STE 260
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5372
Practice Address - Country:US
Practice Address - Phone:618-767-3235
Practice Address - Fax:618-624-4992
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2024-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301096843207R00000X, 207RG0100X
IL036171354207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine