Provider Demographics
NPI:1447543475
Name:TRIPATHI, SHIVANI VIKRAM (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:VIKRAM
Last Name:TRIPATHI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8123
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-2643
Mailing Address - Fax:314-747-8693
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DIV IM DERMATOLOGY, STE 502
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-273-3376
Practice Address - Fax:314-454-4232
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO2014025280207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200062776Medicaid