Individual
DR. SINEE DISTHA-BANCHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1402 S GRAND BLVD, DIVISION OF NEPHROLOGY (9-FDT), SAINT LOUIS, MO 63104-1004
(314) 577-8765
Mailing address
1402 S GRAND BLVD, DIVISION OF NEPHROLOGY (9-FDT), SAINT LOUIS, MO 63104-1004
(314) 577-8765
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2012037985
MO
207RN0300X
Nephrology Physician
Primary
2012037985
MO
Other
Enumeration date
11/09/2012
Last updated
11/09/2012
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