Provider Demographics
NPI:1881900124
Name:ST. LOUIS INFECTIOUS DISEASE SPECIALISTS, LLC
Entity type:Organization
Organization Name:ST. LOUIS INFECTIOUS DISEASE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-624-0220
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:10 FENTON PLAZA
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-0713
Mailing Address - Country:US
Mailing Address - Phone:618-624-0220
Mailing Address - Fax:
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:618-670-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019273207RI0200X
MO2004025502207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty