Healthcare Provider Details

I. General information

NPI: 1760482384
Provider Name (Legal Business Name): SHARAD P PARIKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

3450 BRIDGELAND DR STE F
BRIDGETON MO
63044-2605
US

IV. Provider business mailing address

3450 BRIDGELAND DR STE F
BRIDGETON MO
63044-2605
US

V. Phone/Fax

Practice location:
  • Phone: 314-831-4200
  • Fax: 314-831-7632
Mailing address:
  • Phone: 314-831-4200
  • Fax: 314-831-7632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number33867
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: