Healthcare Provider Details

I. General information

NPI: 1073192324
Provider Name (Legal Business Name): NISHA BHUPESH PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 HIGHLANDS PLAZA DR E STE 300
SAINT LOUIS MO
63110-1353
US

IV. Provider business mailing address

660 S EUCLID AVE CAMPUS BOX 8122-0021-03
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-8670
  • Fax:
Mailing address:
  • Phone: 314-454-7376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number2025012240
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31676
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72019
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: