Healthcare Provider Details

I. General information

NPI: 1023070810
Provider Name (Legal Business Name): KESHAV SHIVRAM JOSHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR SUITE 275
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

1207 MAPLE ST
FARMINGTON MO
63640-7616
US

V. Phone/Fax

Practice location:
  • Phone: 314-469-6200
  • Fax: 314-469-6206
Mailing address:
  • Phone: 573-756-3000
  • Fax: 573-756-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR4B81
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberR4B81
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: