Healthcare Provider Details

I. General information

NPI: 1003346099
Provider Name (Legal Business Name): ANISHA BHANGAV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SOUTH EUCLID STREET CAMPUS BOX 8111
ST. LOUIS MO
63110
US

IV. Provider business mailing address

660 S EUCLID AVE NEUROMUSCULAR DEPT. CAMPUS BOX 8111
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-6991
  • Fax:
Mailing address:
  • Phone: 314-362-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: