Provider Demographics
NPI:1699255935
Name:WEST COUNTY DIABETES AND ENDOCRINOLOGY CENTER PC
Entity type:Organization
Organization Name:WEST COUNTY DIABETES AND ENDOCRINOLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURKIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHINDSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-598-1545
Mailing Address - Street 1:PO BOX 411193
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-3193
Mailing Address - Country:US
Mailing Address - Phone:314-627-1627
Mailing Address - Fax:314-485-2374
Practice Address - Street 1:1023 EXECUTIVE PARKWAY DR STE 2
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6323
Practice Address - Country:US
Practice Address - Phone:314-627-1627
Practice Address - Fax:314-485-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025626207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500062705Medicaid