Individual
VIVEK K MANCHANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4122 KEATON CROSSING BLVD, SUITE 102, O FALLON, MO 63368-8218
(636) 329-9077
(636) 329-9076
Mailing address
4122 KEATON CROSSING BLVD, SUITE 102, O FALLON, MO 63368-8218
(636) 329-9077
(636) 329-9076
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2006017511
MO
208VP0000X
Pain Medicine Physician
Primary
2006017511
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083729941
—
MO
01
—
431560263
TRICARE WEST
MO
01
—
7233350001
NORIDIAN , MEDICARE DME
MO
01
—
P00836305
RAILROAD MEDICARE
—
01
—
P01433382
RAILROAD MEDICARE PROVIDER PTAN
MO
Enumeration date
08/20/2006
Last updated
04/26/2015
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