Healthcare Provider Details

I. General information

NPI: 1942135207
Provider Name (Legal Business Name): KESHAV SRIVATHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

4910 W PINE BLVD APT 208
SAINT LOUIS MO
63108-1977
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7578
  • Fax:
Mailing address:
  • Phone: 713-575-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026027200
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: