Healthcare Provider Details

I. General information

NPI: 1639283195
Provider Name (Legal Business Name): CHENNAIAH NADINDLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BOND AVE
EAST SAINT LOUIS IL
62207-2326
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 618-332-5212
  • Fax:
Mailing address:
  • Phone: 314-872-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036052876
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6025
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: