| Doctor Name: | MRS. ANITA DEWAN |
| NPI Number: | 1174926224 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 036.061456 |
| Business Practice Address: | 9917 Grandview Forest Ct Saint Louis, MO - 631270046 |
| Business Phone Number: | 6185308494 |
| Business Fax Number: | 3147291234 |
| Mailing Address: | 9917 Grandview Forest Ct, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631270046 |
| Phone Number: | 6185308494 |
| Fax Number: | 3147291234 |
| NPI Enumeration Date: | 10/03/2014 |
| NPI Last Update Date: | 10/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 036.061456 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |