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General NPI Number Information
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NPI Number | 1396288106
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Entity Type | Organization
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Legal Business Name | PHYSICIAN SERVICES AND CONSULTING, LLC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 10004 KENNERLY RD STE 295B
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2177
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Country | US
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Telephone | 314-500-2424
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 66738 # 19038
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City | ST LOUIS
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State | MO
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Zip | 63166
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEEPU SUDHAKARAN
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Credential | MD
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Telephone | 314-412-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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