MEDICARE: PRANAV SOMASEKHAR YAYAVARAM 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	207R00000X	Internal Medicine Physician	2025012488	MO

General Provider Information

NPI Number	:	1366191231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRANAV SOMASEKHAR YAYAVARAM MD

Provider Business Mailing Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1328
Fax Number	:	314-525-1378

Provider Business Practice Location Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1328
Fax Number	:	314-525-1378

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

Provider Enumeration Date	:	03/19/2022
Last Update Date	:	12/03/2025

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