Healthcare Provider Details

I. General information

NPI: 1578769006
Provider Name (Legal Business Name): ANAND V. PALAGIRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 537
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6990
  • Fax: 314-251-6998
Mailing address:
  • Phone: 314-251-6990
  • Fax: 314-251-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number2006016944
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: