Provider Demographics
NPI:1063597664
Name:SHARAD P. PARIKH M.D.
Entity type:Organization
Organization Name:SHARAD P. PARIKH M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARAD
Authorized Official - Middle Name:P
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-972-0100
Mailing Address - Street 1:11905 W FLORISSANT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6778
Mailing Address - Country:US
Mailing Address - Phone:314-972-0100
Mailing Address - Fax:314-831-7632
Practice Address - Street 1:11905 W FLORISSANT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6778
Practice Address - Country:US
Practice Address - Phone:314-972-0100
Practice Address - Fax:314-831-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33867291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO710886508Medicaid
MOP00653140OtherRAILROAD MEDICARE
ILP00657419OtherRAILROAD MEDICARE
MO330001780OtherRAILROAD MEDICARE
703360Medicare PIN
MOP00653140OtherRAILROAD MEDICARE
ILP00657419OtherRAILROAD MEDICARE
MO330001780OtherRAILROAD MEDICARE
MO710886508Medicaid