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General NPI Number Information
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NPI Number | 1669487799
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Entity Type | Organization
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Legal Business Name | S BATTULA MD LLC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 5700 MEXICO RD STE 8
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City | SAINT PETERS
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State | MO
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Zip | 63376-1667
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Country | US
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Telephone | 636-477-6464
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Fax | 636-410-9291
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Provider Business Mailing Address
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Address Line | 5700 MEXICO RD STE 8
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City | SAINT PETERS
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State | MO
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Zip | 63376-1667
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Country | US
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Telephone | 636-477-6464
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Fax | 636-410-9291
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Authorized Official
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Title or Position | OWNER
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Name | SRINIVAS BATTULA
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Credential | MD
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Telephone | 636-477-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2006009277
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License Number State | MO
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