Provider Demographics
NPI:1457420408
Name:SARLI, RICARDO NESTOR (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:NESTOR
Last Name:SARLI
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 1:1402 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1004
Mailing Address - Country:US
Mailing Address - Phone:314-977-4547
Mailing Address - Fax:314-977-7615
Practice Address - Street 1:1402 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1004
Practice Address - Country:US
Practice Address - Phone:314-977-4547
Practice Address - Fax:314-977-7615
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036150171207ZH0000X, 207ZP0102X
MO109552207ZH0000X, 207ZP0102X
ND11381207ZP0102X
NY273456207ZP0102X
PAMD450705207ZP0102X
NH33773207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16819Medicaid
ND16819Medicaid
MOF52885Medicare UPIN
MO705866705Medicaid
MO006013687Medicare ID - Type UnspecifiedMEDICARE-TRI-LAKES
MOF52885Medicare UPIN
MO006013688Medicare ID - Type UnspecifiedMEDICARE-TRI-LAKES
ND717689Medicare PIN
MO159012OtherBLUE CROSS BLUE SHIELD-TR
MO007010385Medicare ID - Type UnspecifiedMEDICARE
MO1100107OtherUNITED HEALTHCARE
MO700100407Medicaid
MO1559OtherBLUE CROSS BLUE SHIELD-PA
MO421439307OtherFED TAX ID-TRI-LAKES PATH
MO220018224Medicare ID - Type UnspecifiedRAILROAD MEDICARE-PATHOLO