Provider Demographics
NPI:1871586156
Name:UPPAL, PRAVEENA (MD)
Entity type:Individual
Prefix:
First Name:PRAVEENA
Middle Name:
Last Name:UPPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRAVEENA
Other - Middle Name:
Other - Last Name:UPPAL
Other - Suffix:IX
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:STE 315E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-355-7500
Practice Address - Fax:314-355-3287
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006024933207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA277060OtherANTHEM
VA005871557Medicaid
VAH23947Medicare UPIN
VA005871557Medicaid