MEDICARE: DR. MAHENDRA GUNAPOOTI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	2004022990	MO
2	208VP0014X	Interventional Pain Medicine Physician	036112334	IL

General Provider Information

NPI Number	:	1114034931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHENDRA GUNAPOOTI MD

Provider Business Mailing Address
First Line	:	PO BOX 650
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-0650
Country	:	US
Telephone Number	:	314-830-2600
Fax Number	:	314-830-2648

Provider Business Practice Location Address
First Line	:	261 DUNN RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-7928
Country	:	US
Telephone Number	:	314-830-2600
Fax Number	:	314-830-2648

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/09/2026

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