MEDICARE: PRAVEENA UPPAL 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	207RP1001X	Pulmonary Disease Physician	2006024933	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	277060	OTHER	VA	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871586156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAVEENA UPPAL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11155 DUNN RD
Second Line	:	STE 315E
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6150
Country	:	US
Telephone Number	:	314-355-7500
Fax Number	:	314-355-3287

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	10/27/2020

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