Healthcare Provider Details

I. General information

NPI: 1932349792
Provider Name (Legal Business Name): VIKAS DHAWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CHESTERFIELD BUSINESS PKWY
CHESTERFIELD MO
63005-1233
US

IV. Provider business mailing address

157 CHESTERFIELD BUSINESS PKWY
CHESTERFIELD MO
63005-1233
US

V. Phone/Fax

Practice location:
  • Phone: 618-500-5888
  • Fax: 314-451-8885
Mailing address:
  • Phone: 618-500-5888
  • Fax: 314-451-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number2019047271
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number43350
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number036174389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: