MEDICARE: MR. GURPREET PADDA 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	100572	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	7200000096	OTHER	MO	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118505	OTHER	MO	GHP
2	4647144	OTHER	MO	AETNA
3	149848	OTHER	MO	BLUE CROSS BLUE SHILED
5	175746	OTHER	MO	HELATH LINK
6	2001272	OTHER	MO	UHC

General Provider Information

NPI Number	:	1427035955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GURPREET PADDA M.D

Provider Business Mailing Address
First Line	:	5203 CHIPPEWA ST
Second Line	:	SUITE 301
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2356
Country	:	US
Telephone Number	:	314-481-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5203 CHIPPEWA ST
Second Line	:	SUITE 301
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2356
Country	:	US
Telephone Number	:	314-481-5000
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	02/18/2011

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Directions to “ MR. GURPREET PADDA M.D” Practice Location

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