Healthcare Provider Details

I. General information

NPI: 1770502056
Provider Name (Legal Business Name): INDERJIT SINGH MD FACP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD SUITE 207N
SAINT LOUIS MO
63136-6150
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 Number036090622
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number112064
License Number StateMO

VIII. Authorized Official

Name: MS. JACKI JORDAN
Title or Position: BILLING MANAGER
Credential:
Phone: 314-432-2580