Provider Demographics
NPI:1710036025
Name:HEGDE, BIJOY (MD)
Entity type:Individual
Prefix:
First Name:BIJOY
Middle Name:
Last Name:HEGDE
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 1:13238 AUTUMN TRAILS CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-3210
Mailing Address - Country:US
Mailing Address - Phone:314-814-2051
Mailing Address - Fax:
Practice Address - Street 1:13238 AUTUMN TRAILS CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-3210
Practice Address - Country:US
Practice Address - Phone:314-814-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107053208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
H60936Medicare UPIN
MO206572Medicare ID - Type Unspecified