Provider Demographics
NPI:1154378073
Name:ANAND, DESH V (MD)
Entity type:Individual
Prefix:DR
First Name:DESH
Middle Name:V
Last Name:ANAND
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 1:1111 W. PEARCE BLVD
Mailing Address - Street 2:ATTENTION: CREDENTIALING SUPERVISOR
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1020
Mailing Address - Country:US
Mailing Address - Phone:636-887-4288
Mailing Address - Fax:636-639-2368
Practice Address - Street 1:1111 W. PEARCE BLVD.
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1020
Practice Address - Country:US
Practice Address - Phone:636-887-4288
Practice Address - Fax:636-639-2368
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113402207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204902035Medicaid
IL$$$$$$$$$Medicaid
MO907435009Medicare PIN
MO907435005Medicare PIN
MO907434740Medicare PIN
MO204902035Medicaid
MO907434748Medicare PIN
MOG90902Medicare UPIN
MO080050113Medicare ID - Type UnspecifiedMEDICARE