Provider Demographics
NPI:1518962240
Name:DAHUJA, MANOJPAL S (MD)
Entity type:Individual
Prefix:DR
First Name:MANOJPAL
Middle Name:S
Last Name:DAHUJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1603 WENTZVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3826
Mailing Address - Country:US
Mailing Address - Phone:636-332-8228
Mailing Address - Fax:636-332-1190
Practice Address - Street 1:1603 WENTZVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3826
Practice Address - Country:US
Practice Address - Phone:636-332-8228
Practice Address - Fax:636-332-1190
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006023270174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518962240Medicaid
H40618Medicare UPIN
141120001Medicare PIN