Manchanda, Vivek K
Manchanda, Vivek K is an individual health care provider with primary practice located at 4122 Keaton Crossing Blvd Suite 102, O Fallon MO 63368-8218. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Manchanda, Vivek K can be contacted via phone (636) 329-9077.Contact Information
Primary practice address
4122 Keaton Crossing Blvd Suite 102
O Fallon MO 63368-8218
Phone: (636) 329-9077
Fax: (636) 329-9076
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 2006017511 | Missouri |
| Allopathic & Osteopathic Physicians / Pain Medicine | 208VP0000X | 2006017511 | Missouri |
Profile Details
| NPI number | 1083729941 |
|---|---|
| LBN Legal business name | Manchanda, Vivek K |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 20th, 2006 |
| Last updated | Apr 26th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083729941 | NPPES |
| Missouri | Other | 431560263 | TRICARE WEST |
| Missouri | Other | P01433382 | TRICARE WEST |
| Missouri | Other | 7233350001 | TRICARE WEST |
| Missouri | Other | P00836305 | TRICARE WEST |
| Missouri | MEDICAID | 1083729941 | TRICARE WEST |
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