Individual
DR. PRAVESH P DEOTALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1420 US HIGHWAY 61, FESTUS, MO 63028-4108
(636) 543-2230
Mailing address
9 HIGH ACRES DR, SAINT LOUIS, MO 63132-4210
(217) 414-5131
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
036135582
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2015036367
MO
Other
Enumeration date
07/19/2011
Last updated
04/24/2025
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