Healthcare Provider Details

I. General information

NPI: 1982891271
Provider Name (Legal Business Name): KIRUBAHARA VAHEESAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 N NEW BALLAS RD
SAINT LOUIS MO
63141-6713
US

IV. Provider business mailing address

641 N NEW BALLAS RD
SAINT LOUIS MO
63141-6713
US

V. Phone/Fax

Practice location:
  • Phone: 314-888-4647
  • Fax: 314-514-4014
Mailing address:
  • Phone: 314-888-4647
  • Fax: 314-514-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2011-01362
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2012038839
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: