Healthcare Provider Details

I. General information

NPI: 1790783538
Provider Name (Legal Business Name): RAJIV R HANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD STE 300
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD STE 300
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-692-2807
  • Fax: 314-991-0727
Mailing address:
  • Phone: 314-692-2807
  • Fax: 314-991-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2004010191
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number199566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: