MEDICARE: DR. MANOKIRAN PATRI 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	174400000X	Specialist	036-104049	IL
2	207RI0200X	Infectious Disease Physician	2009027341	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-104049	OTHER	IL	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1649204173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANOKIRAN PATRI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 504934
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-4934
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 1ST CAPITOL DR STE 260
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2888
Country	:	US
Telephone Number	:	636-925-0900
Fax Number	:	636-925-0960

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/14/2021

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