Basic Information
| Provider Information | |||||||||
| NPI: | 1659598225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOOD | ||||||||
| FirstName: | ANSHU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 POWELL ST | ||||||||
| Address2: | STE 900 | ||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502842 | ||||||||
| FaxNumber: | 5108799128 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 S NEW BALLAS RD STE 3016B | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142516339 | ||||||||
| FaxNumber: | 3142514564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036119834 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0000X | 5158 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | 208M00000X | 036119834 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 2012011183 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 2012011183 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5158 | 01 | NE | TEP | OTHER | 036119834 | 05 | IL | MEDICAID | 1659598225 | 05 | IL | MEDICAID |