Provider Demographics
NPI:1023218807
Name:MUKERJI, RITA (MD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:MUKERJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-953-6300
Mailing Address - Fax:314-953-6309
Practice Address - Street 1:1225 GRAHAM RD STE C-2310
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-953-6300
Practice Address - Fax:314-953-6309
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010015033207RI0011X, 207RC0000X
IL036138092207RI0011X, 208M00000X
IN01070696A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201056370Medicaid
IN201056370Medicaid
MO152360328Medicare PIN