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General NPI Number Information
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NPI Number | 1720475403
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Entity Type | Individual
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Provider Name | SHANKER DAS KUNDUMADAM MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 1390 US HIGHWAY 61 STE N3300
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City | FESTUS
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State | MO
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Zip | 63028-4137
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Country | US
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Telephone | 636-937-8675
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Fax | 636-933-1981
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Provider Business Mailing Address
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Address Line | 1390 US HIGHWAY 61 STE N3300
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City | FESTUS
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State | MO
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Zip | 63028-4137
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Country | US
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Telephone | 636-937-8675
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Fax | 636-933-1981
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD-49141
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2024046631
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License Number State | MO
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