Healthcare Provider Details

I. General information

NPI: 1376855817
Provider Name (Legal Business Name): SACHIN MALLANAGOUDA PATIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 7411626
CHICAGO IL
60674-5626
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8788
  • Fax: 573-882-3131
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2018019524
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2018019524
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: