Healthcare Provider Details

I. General information

NPI: 1194222695
Provider Name (Legal Business Name): TULSI MANOJ PANDAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 09/30/2025
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 DUNCAN AVE DIV ORTHO SURGERY NEUROREHAB
SAINT LOUIS MO
63110-1111
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-3500
  • Fax: 314-747-2598
Mailing address:
  • Phone: 314-514-3500
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2025035821
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: