MEDICARE: DR. ANJALI K PATHAK MD

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	207W00000X	Ophthalmology Physician	2001009907	MO

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	:	1699791913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJALI K PATHAK MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	C B 8096
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-275-2020
Fax Number	:	314-275-8719

Provider Business Practice Location Address
First Line	:	10 BARNES WEST DR
Second Line	:	STE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6350
Country	:	US
Telephone Number	:	314-996-3300
Fax Number	:	314-996-3301

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/26/2015

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