Healthcare Provider Details

I. General information

NPI: 1396867032
Provider Name (Legal Business Name): SUMESH KASWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S SPRING AVE
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2000
  • Fax:
Mailing address:
  • Phone: 314-977-4722
  • Fax: 314-977-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2014006063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: