Provider Demographics
NPI:1225901069
Name:DHITAL, PRAJA
Entity type:Individual
Prefix:
First Name:PRAJA
Middle Name:
Last Name:DHITAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5494 BROWN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1100
Mailing Address - Country:US
Mailing Address - Phone:314-837-8067
Mailing Address - Fax:314-584-2163
Practice Address - Street 1:5494 BROWN RD STE 107
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1100
Practice Address - Country:US
Practice Address - Phone:314-837-8067
Practice Address - Fax:314-584-2163
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health