Healthcare Provider Details

I. General information

NPI: 1598749004
Provider Name (Legal Business Name): RISHI NATH SUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 TARA OAKS DR
CHESTERFIELD MO
63005-3656
US

IV. Provider business mailing address

977 TARA OAKS DR
CHESTERFIELD MO
63005-3656
US

V. Phone/Fax

Practice location:
  • Phone: 773-636-1646
  • Fax: 314-390-5404
Mailing address:
  • Phone: 773-636-1646
  • Fax: 314-390-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2017031914
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: