Healthcare Provider Details

I. General information

NPI: 1922948900
Provider Name (Legal Business Name): KAVITA DESAI KRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1700 FORUM BLVD APT 2607
COLUMBIA MO
65203-6346
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4141
  • Fax:
Mailing address:
  • Phone: 314-518-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2026021658
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: