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General NPI Number Information
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NPI Number | 1043494685
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Entity Type | Organization
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Legal Business Name | PRABHA PARTAP MD
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 777 S NEW BALLAS RD SUITE 301E
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8705
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Country | US
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Telephone | 314-692-0117
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Fax | 314-993-6194
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Provider Business Mailing Address
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Address Line | 777 S NEW BALLAS RD SUITE 301E
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8705
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Country | US
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Telephone | 314-692-0117
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Fax | 314-993-6194
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Authorized Official
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Title or Position | PATHOLOGIST / LAB DIRECTOR
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Name | DR. PRABHA PARTAP
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Credential | MD
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Telephone | 314-821-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 35538
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License Number State | MO
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