Provider Demographics
NPI:1811240773
Name:BHUYAN, MAHENDRA (MBBS, MD)
Entity type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:
Last Name:BHUYAN
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FOUNTAIN LAKE BLVD.
Mailing Address - Street 2:PRACS INSTITUTE
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-0518
Mailing Address - Country:US
Mailing Address - Phone:636-947-1200
Mailing Address - Fax:636-723-5888
Practice Address - Street 1:400 FOUNTAIN LAKE BLVD.
Practice Address - Street 2:PRACS INSTITUTE
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-0518
Practice Address - Country:US
Practice Address - Phone:636-947-1200
Practice Address - Fax:636-723-5888
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine