Healthcare Provider Details

I. General information

NPI: 1518528082
Provider Name (Legal Business Name): SANDEEP RANDHAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES-JEWISH HOSPITAL PLAZA, DIV IM CARDIOLOGY
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 60352, DEPT OF INTERNAL MEDICINE
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1291
  • Fax: 314-747-1417
Mailing address:
  • Phone: 314-362-1291
  • Fax: 314-747-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2026018082
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: