Healthcare Provider Details

I. General information

NPI: 1710036025
Provider Name (Legal Business Name): BIJOY HEGDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13238 AUTUMN TRAILS CT
SAINT LOUIS MO
63141-3210
US

IV. Provider business mailing address

13238 AUTUMN TRAILS CT
SAINT LOUIS MO
63141-3210
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-2051
  • Fax:
Mailing address:
  • Phone: 314-814-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036107053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: