Healthcare Provider Details

I. General information

NPI: 1427404102
Provider Name (Legal Business Name): NIKOLETA BRANKOV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WEBER HILL RD STE 200
SAINT LOUIS MO
63127-1569
US

IV. Provider business mailing address

12200 WEBER HILL RD STE 200
SAINT LOUIS MO
63127-1569
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-5660
  • Fax: 314-842-0169
Mailing address:
  • Phone: 314-842-5660
  • Fax: 314-842-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2025003838
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number64741
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number64741
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: