Basic Information
| Provider Information | |||||||||
| NPI: | 1619167483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHILLON | ||||||||
| FirstName: | RUPINDERJIT | ||||||||
| MiddleName: | SINGH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11550 OLIVE BLVD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | CREVE COEUR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631417111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142058344 | ||||||||
| FaxNumber: | 3145905931 | ||||||||
| Practice Location | |||||||||
| Address1: | 11550 OLIVE BLVD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | CREVE COEUR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631417111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142058344 | ||||||||
| FaxNumber: | 3145905931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD.203869 | LA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 2015001549 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1000673 | 05 | LA | MEDICAID | 05374052 | 05 | MS | MEDICAID | 1000671 | 05 | LA | MEDICAID |