Healthcare Provider Details

I. General information

NPI: 1447215488
Provider Name (Legal Business Name): ABHINAV DIWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-7030
  • Fax:
Mailing address:
  • Phone: 314-362-1291
  • Fax: 314-362-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2008018936
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: