Healthcare Provider Details

I. General information

NPI: 1992793145
Provider Name (Legal Business Name): SADASHIV PARWATIKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 MENARD ST
SAINT LOUIS MO
63104-4140
US

IV. Provider business mailing address

2107 MENARD ST
SAINT LOUIS MO
63104-4140
US

V. Phone/Fax

Practice location:
  • Phone: 314-776-0337
  • Fax: 314-776-7504
Mailing address:
  • Phone: 314-776-0337
  • Fax: 314-776-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberR4268
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: