Healthcare Provider Details

I. General information

NPI: 1265416697
Provider Name (Legal Business Name): HIRALAL TURSHAMAL TEKWANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 KENNERLY RD
SAINT LOUIS MO
63128-2700
US

IV. Provider business mailing address

9911 KENNERLY RD
SAINT LOUIS MO
63128-2700
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-2020
  • Fax: 314-842-1407
Mailing address:
  • Phone: 314-842-2020
  • Fax: 314-842-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33926
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: