Healthcare Provider Details

I. General information

NPI: 1255176012
Provider Name (Legal Business Name): RISHI GONUGUNTLA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEW HOSP PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE, CB 03
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-369-3621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2026023629
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: