Provider Demographics
NPI:1154375970
Name:PANDE, SANGEETA (MD)
Entity type:Individual
Prefix:DR
First Name:SANGEETA
Middle Name:
Last Name:PANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11155 DUNN RD
Mailing Address - Street 2:STE 211N
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6166
Mailing Address - Country:US
Mailing Address - Phone:314-741-1600
Mailing Address - Fax:314-741-1677
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-741-1600
Practice Address - Fax:314-741-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000155017207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209092907Medicaid
MO431965218OtherEMPLOYER TAX ID#
MO431965218OtherEMPLOYER TAX ID#
MOI20174Medicare UPIN
MO209092907Medicaid