Healthcare Provider Details

I. General information

NPI: 1275594590
Provider Name (Legal Business Name): HARMEEN CHAWLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD 4TH FLOOR - ACUTE REHAB
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

12639 OLD TESSON RD
SAINT LOUIS MO
63128-2786
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-4522
  • Fax: 314-525-4598
Mailing address:
  • Phone: 314-849-0311
  • Fax: 314-849-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number111033
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: