| Organization Name: | DESILVA MEDICAL SERVICES LLC |
| NPI Number: | 1184757072 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANANDA DESILVA (PHYSICIAN OWNER) |
| Mailing Address: | 6308 Hazelwest Ct Suite 200 Hazelwood |
| State: | MO US |
| Postal Code: | 630421739 |
| Phone Number: | 3147315555 |
| Fax Number: | 3147315558 |
| NPI Enumeration Date: | 03/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RA0000X |
| License Number: | R9845 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Adolescent Medicine |
| Taxonomy Definition: | An internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |