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General NPI Number Information
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NPI Number | 1568670917
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Entity Type | Individual
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Provider Name | MRUDULA PENTA MD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 300 FIRST CAPITAL DRIVE
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City | ST CHARLES
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State | MO
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Zip | 63301
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Country | US
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Telephone | 636-947-5444
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Fax | 636-947-5259
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Provider Business Mailing Address
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Address Line | 220 COMPASS POINT DRIVE
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City | ST CHARLES
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State | MO
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Zip | 63301
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Country | US
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Telephone | 636-947-4480
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Fax | 636-947-9860
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A130188
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2025021480
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | A130188
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License Number State | CA
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