Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | R7446 | MO |
NPI | 1043290588 |
---|---|
Provider Name | Korgi V Hegde |
First Address | Saint Louis, MO 63177-7043 |
Second Address | Saint Louis, MO 63143-2112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 14/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100652 | HEALTHLINK (01) | MO |
101893 | GHP/ADVANTRA - COVENTRY (01) | MO |
152780 | BLUE PRODUCTS (01) | MO |
201014115 | (05) | MO |
4331147 | AETNA (01) | |
4800233 | UNITED HEALTHCARE (01) | MO |
A29034 | (02) |