Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2017005744 | MO |
N | 208000000X | Pediatrician | 4301094393 | MI |
Y | 2080P0203X | Pediatric Critical Care Doctor | 2017005744 | MO |
N | 2080P0203X | Pediatric Critical Care Doctor | 4301094393 | MI |
NPI | 1265665855 |
---|---|
Provider Name | Dr. Saurabh Shankar Chiwane |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2009 |
Last Update Date | 11/03/2021 |