Healthcare Provider Details

I. General information

NPI: 1811946783
Provider Name (Legal Business Name): RAVINDRA V SHITUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD SUITE 301
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-8250
  • Fax: 314-953-8255
Mailing address:
  • Phone: 314-953-8250
  • Fax: 314-953-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR6C08
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: