Provider Demographics
NPI:1144464546
Name:IKEDA, SHIGEMASA (MD)
Entity type:Individual
Prefix:
First Name:SHIGEMASA
Middle Name:
Last Name:IKEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CHESHIRE FARM CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8502
Mailing Address - Country:US
Mailing Address - Phone:314-434-0095
Mailing Address - Fax:
Practice Address - Street 1:3635 VISTA AVE. AT GRAND BLVD
Practice Address - Street 2:DEPT. ANESTHESIOLOGY & CRITICAL CARE, SLUH
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-0250
Practice Address - Country:US
Practice Address - Phone:314-577-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5870207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology