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NPI Code Detail

MEDICARE: DR. VIJAY K PATNANA M.D.

MEDICARE: DR. VIJAY K PATNANA 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
1207L00000XAnesthesiology Physician2001019664MO

General Provider Information

NPI Number : 1366448722
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VIJAY K PATNANA M.D.
Provider Business Mailing Address
First Line : 351 CONSORT DR
Second Line :
City : BALLWIN
State : MO
Zip : 63011-4439
Country : US
Telephone Number : 636-200-4242
Fax Number : 636-200-4243
Provider Business Practice Location Address
First Line : 17050 BAXTER RD
Second Line : SUITE #110
City : CHESTERFIELD
State : MO
Zip : 63005-1422
Country : US
Telephone Number : 636-200-4242
Fax Number : 636-200-4243
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 10/26/2007

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