Healthcare Provider Details

I. General information

NPI: 1356306823
Provider Name (Legal Business Name): DEEPA HASMUKHLAL CHAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL DIV PED NEPHROLOGY
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL MSC 8515-87-1200
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6043
  • Fax: 888-463-6898
Mailing address:
  • Phone: 314-454-6043
  • Fax: 888-463-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018041661
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number2018041661
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: