1699856443 NPI number — DR. MIGUEL ANGEL PANIAGUA M.D./M.P.H.

Table of content: DR. MIGUEL ANGEL PANIAGUA M.D./M.P.H. (NPI 1699856443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699856443 NPI number — DR. MIGUEL ANGEL PANIAGUA M.D./M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANIAGUA
Provider First Name:
MIGUEL
Provider Middle Name:
ANGEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D./M.P.H.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANIAGUA
Provider Other First Name:
MIGUEL
Provider Other Middle Name:
ANGEL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D./ M.P.H.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699856443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1532 FOUNTAINHEAD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63138-3339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-355-3873
Provider Business Mailing Address Fax Number:
314-355-7383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12414 LUSHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63138-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-741-2500
Provider Business Practice Location Address Fax Number:
314-741-0880
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  036046269 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: R4B44 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 370983349 . This is a "PANIAGUA MEDICAL LTD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 192033 . This is a "BCBSMO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 125391 . This is a "PHCS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5709126 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: D04066 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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