Healthcare Provider Details

I. General information

NPI: 1255714663
Provider Name (Legal Business Name): ANKITA KANTILAL VORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE STE 2600
SAINT LOUIS MO
63108
US

IV. Provider business mailing address

4444 FOREST PARK AVE STE 2600
SAINT LOUIS MO
63108-2212
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1700
  • Fax:
Mailing address:
  • Phone: 314-286-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2015016479
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2015016479
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: