Healthcare Provider Details

I. General information

NPI: 1386755056
Provider Name (Legal Business Name): RACHANDEEP SINGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HOSPITAL DR SUITE 225
OSAGE BEACH MO
65065-3050
US

IV. Provider business mailing address

PO BOX 1500
OSAGE BEACH MO
65065-1500
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-2762
  • Fax: 573-302-2268
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2008015506
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2008015506
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC129918
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00683847
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier1386755056
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: