Bodavula MD LLC
Clinic/Center in Creve Coeur, MO. Organization (NPI-2).
NPI number1790183077
StatusActive
Last updated in NPPESDec 18, 2014
Details
- NPI
- 1790183077
- Entity type
- Organization (NPI-2)
- Legal business name
- Bodavula MD LLC
- Organization subpart
- No
- Enumeration date
- Dec 18, 2014
- Last updated
- Dec 18, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | 2010007564 | MO | Yes |
Practice location
709 Turrentine TrlCreve Coeur, MO 63141-6089
Phone 914-563-2943
Mailing address
709 Turrentine TrlCreve Coeur, MO 63141-6089
Phone 914-563-2943
Authorized official
Venkata Kr Bodavula
Surgeon
9145632943
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