Individual
DR. AMIT MATHUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5663
(314) 268-6410
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5663
(314) 268-6410
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
107167
MO
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
107167
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203875505
—
MO
05
—
ENROLLED
—
IL
Enumeration date
07/18/2006
Last updated
01/18/2021
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