Basic Information
| Provider Information | |||||||||
| NPI: | 1730490525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHRESTHA | ||||||||
| FirstName: | AMARDEEP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 N GREEN MOUNT RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622693466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175446464 | ||||||||
| FaxNumber: | 2177576805 | ||||||||
| Practice Location | |||||||||
| Address1: | 1480 N GREEN MOUNT RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622693466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186223450 | ||||||||
| FaxNumber: | 6186223468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2010 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125.058380 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036.132849 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 036.132849 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.