Healthcare Provider Details

I. General information

NPI: 1649223561
Provider Name (Legal Business Name): ANNU A. TERKONDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 SUNSET OFFICE DR STE. C
SAINT LOUIS MO
63127-1015
US

IV. Provider business mailing address

10777 SUNSET OFFICE DR STE. 310
SAINT LOUIS MO
63127-1019
US

V. Phone/Fax

Practice location:
  • Phone: 314-238-9100
  • Fax: 314-238-9110
Mailing address:
  • Phone: 314-822-5900
  • Fax: 314-822-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number105686
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number105686
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: