Healthcare Provider Details

I. General information

NPI: 1720615172
Provider Name (Legal Business Name): TARUSH KHURANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5034 GRIFFIN RD
SAINT LOUIS MO
63128-3418
US

IV. Provider business mailing address

PO BOX 419052
SAINT LOUIS MO
63141-9052
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-7333
  • Fax: 314-843-9946
Mailing address:
  • Phone: 314-851-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023025580
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: