MEDICARE: DR. VASANTHA P PAI M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	036097852	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306921218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASANTHA P PAI M.D

Provider Business Mailing Address
First Line	:	2810 FRANK SCOTT PKWY W STE 716
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-5007
Country	:	US
Telephone Number	:	618-355-0880
Fax Number	:	618-355-0881

Provider Business Practice Location Address
First Line	:	2810 FRANK SCOTT PKWY W STE 716
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-5007
Country	:	US
Telephone Number	:	618-355-0880
Fax Number	:	618-355-0881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/26/2016

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