MEDICARE: KAVITHA KOSURI D.O.

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	207RX0202X	Medical Oncology Physician	34008023	OH
2	207RX0202X	Medical Oncology Physician	R6A19	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01351475	OTHER	MO	RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215981766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVITHA KOSURI D.O.

Provider Business Mailing Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8222
Country	:	US
Telephone Number	:	314-251-4400
Fax Number	:	314-251-6375

Provider Business Practice Location Address
First Line	:	607 S NEW BALLAS RD
Second Line	:	SUITE 3300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8222
Country	:	US
Telephone Number	:	314-251-4400
Fax Number	:	314-251-6375

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/29/2015

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Directions to “ KAVITHA KOSURI D.O.” Practice Location

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