Basic Information
| Provider Information | |||||||||
| NPI: | 1497138838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHAN | ||||||||
| FirstName: | VISHNU | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 955860 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631955389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364985944 | ||||||||
| FaxNumber: | 7135006497 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 GOOD SAMARITAN WAY STE 420 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188994000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2015 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RR0500X | 036154227 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.