=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942596135
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIKRAM SINGH CHAWA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2011
-----------------------------------------------------
Last Update Date | 03/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3691 RUTGER ST 2-DH ANESTHESIOLOGY
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63110-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-577-8762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2352A ALBION PL
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63104-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-883-4365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 2011025487
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------