1639183940 NPI number — DR. RAJINDER M. GULATI MD

Table of content: DR. HEIDI A CLAY MD (NPI 1043223472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639183940 NPI number — DR. RAJINDER M. GULATI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULATI
Provider First Name:
RAJINDER
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639183940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 DOCTORS PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE GIRARDEAU
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63703-4928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-334-6071
Provider Business Mailing Address Fax Number:
573-334-4739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 DOCTORS PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-334-6071
Provider Business Practice Location Address Fax Number:
573-334-4739
Provider Enumeration Date:
07/29/2006

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: 2085N0904X , with the licence number:  2005023119 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 2005023119 , 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: 063896 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036-660634 . This is a "IL BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 123361 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036060634-4 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185214 . This is a "MO BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207354705 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430954380CAP . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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