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General NPI Number Information
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NPI Number | 1306921218
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Entity Type | Individual
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Provider Name | VASANTHA P PAI M.D
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 2810 FRANK SCOTT PKWY W STE 716
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City | BELLEVILLE
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State | IL
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Zip | 62223-5007
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Country | US
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Telephone | 618-355-0880
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Fax | 618-355-0881
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Provider Business Mailing Address
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Address Line | 2810 FRANK SCOTT PKWY W STE 716
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City | BELLEVILLE
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State | IL
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Zip | 62223-5007
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Country | US
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Telephone | 618-355-0880
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Fax | 618-355-0881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036097852
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License Number State | IL
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