Healthcare Provider Details

I. General information

NPI: 1669423034
Provider Name (Legal Business Name): RAJIV SADANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WATERBURY FALLS DRIVE ST CHARLES CBOC
O'FALLON MO
63368
US

IV. Provider business mailing address

13531 COLISEUM DR
CHESTERFIELD MO
63017-3004
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-7676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2011002614
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: