Healthcare Provider Details

I. General information

NPI: 1609842434
Provider Name (Legal Business Name): INDERJIT SINGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD SUITE 207N
SAINT LOUIS MO
63136-6149
US

IV. Provider business mailing address

PO BOX 1125
MARYLAND HEIGHTS MO
63043-0125
US

V. Phone/Fax

Practice location:
  • Phone: 314-736-6590
  • Fax: 314-736-4359
Mailing address:
  • Phone: 314-432-2580
  • Fax: 314-432-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number112064
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-090622
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036-090622
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number112064
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: