Provider Demographics
NPI:1104913896
Name:CHOUDHARY, NAVIN (MD)
Entity type:Individual
Prefix:DR
First Name:NAVIN
Middle Name:
Last Name:CHOUDHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CREEKSIDE OFFICE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-497-6776
Mailing Address - Fax:636-639-1375
Practice Address - Street 1:105 CREEKSIDE OFFICE DRIVE
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-497-6776
Practice Address - Fax:636-639-1375
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007036351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007036351OtherMISSOURI LICENSE
MOH96988Medicare UPIN