Healthcare Provider Details

I. General information

NPI: 1639267149
Provider Name (Legal Business Name): MILAN JATIN ANADKAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DIV IM DERMATOLOGY, STE 502
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-3376
  • Fax: 888-665-8309
Mailing address:
  • Phone: 314-273-3376
  • Fax: 888-665-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2002016468
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: