Individual provider · NPI-1

Dr. Sreenivasulu Bogachenchu, MD

Internal Medicine · Festus, MO

NPI number1831417070
StatusActive
Last updated in NPPESMar 1, 2022

Details

NPI
1831417070
Entity type
Individual (NPI-1)
Name
Dr. Sreenivasulu Bogachenchu
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
May 12, 2010
Certification date
Mar 1, 2022
Last updated
Mar 1, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine2016010622MOYes
207R00000X Internal Medicine036125603IL
208M00000X Hospitalist036125603IL

Practice location

1400 Us Highway 61
Festus, MO 63028-4100

Phone 636-933-5337

Mailing address

1400 Us Highway 61
Festus, MO 63028-4100

Phone 636-933-5337

Other practice locations

10010 Kennerly Rd
Saint Louis, MO 63128-2106

Phone 314-525-1328 · Fax 314-525-1378

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