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General NPI Number Information
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NPI Number | 1427404102
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Entity Type | Individual
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Provider Name | NIKOLETA BRANKOV MD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 12200 WEBER HILL RD STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1569
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Country | US
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Telephone | 314-842-5660
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Fax | 314-842-0169
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Provider Business Mailing Address
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Address Line | 12200 WEBER HILL RD STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1569
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Country | US
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Telephone | 314-842-5660
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Fax | 314-842-0169
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2025003838
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 64741
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 64741
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License Number State | AZ
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