Provider Demographics
NPI:1740635168
Name:MALHOTRA, NIKHIL (MD)
Entity type:Individual
Prefix:
First Name:NIKHIL
Middle Name:
Last Name:MALHOTRA
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 1:3635 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2539
Mailing Address - Country:US
Mailing Address - Phone:314-577-8762
Mailing Address - Fax:
Practice Address - Street 1:3635 VISTA AVENUE AT GRAND BOULEVARD
Practice Address - Street 2:14TH FLOOR, DESLOGE TOWERS
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:580-278-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM081554323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine