Provider Demographics
NPI:1811946783
Name:SHITUT, RAVINDRA V (MD)
Entity type:Individual
Prefix:DR
First Name:RAVINDRA
Middle Name:V
Last Name:SHITUT
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 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-953-8250
Mailing Address - Fax:314-953-8255
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-953-8250
Practice Address - Fax:314-953-8255
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6C08207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20834OtherBLUE CROSS BLUE SHIELD
MO0900035OtherUNITED HEALTH CARE
MO295099002OtherCIGNA
MO200021279OtherRAILROAD MEDICARE
MO4000999OtherAETNA
MO202017703Medicaid
MO101573OtherHEALTHLINK
MO42919OtherGROUP HEALTH PLAN
MO20834OtherBLUE CROSS BLUE SHIELD
MO200021279OtherRAILROAD MEDICARE