MEDICARE: SURESH NELLORE 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	207RI0200X	Infectious Disease Physician	108767	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144297862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURESH NELLORE MD

Provider Business Mailing Address
First Line	:	10004 KENNERLY RD STE 295B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2177
Country	:	US
Telephone Number	:	314-740-2949
Fax Number	:	314-375-5022

Provider Business Practice Location Address
First Line	:	10004 KENNERLY RD STE 295B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2177
Country	:	US
Telephone Number	:	314-740-2949
Fax Number	:	314-375-5020

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	04/16/2025

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Directions to “ SURESH NELLORE MD” Practice Location

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