MEDICARE: DR. DEEPU SUDHAKARAN M.D

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	208600000X	Surgery Physician	036127430	IL
2	208600000X	Surgery Physician	2015033187	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528269214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPU SUDHAKARAN M.D

Provider Business Mailing Address
First Line	:	PO BOX 854
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-0854
Country	:	US
Telephone Number	:	618-993-1400
Fax Number	:	618-993-1522

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	:	314-500-2424
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	03/28/2024

Similar Medicare Providers

1457864175 — AMBER MAHMOOD BOKHARI MD
Practice Location Address:

10004 KENNERLY RD STE 295B
SAINT LOUIS, MO
63128-2177

Practice Phone: 314-791-1108
Practice Fax: 314-375-5020

1629076674 — RAYMOND ABDO DPM
Practice Location Address:

10004 KENNERLY RD STE 259B
SAINT LOUIS, MO
63128-2177

Practice Phone: 314-596-9670
Practice Fax: 314-722-3090

1144297862 — SURESH NELLORE MD
Practice Location Address:

10004 KENNERLY RD STE 295B
SAINT LOUIS, MO
63128-2177

Practice Phone: 314-740-2949
Practice Fax: 314-375-5020

1154345627 — RENEE MICHELLE WILLIAMS MED, LPC
Practice Location Address:

10004 KENNERLY RD STE 280B
SAINT LOUIS, MO
63128-2177

Practice Phone: 314-525-7296
Practice Fax:

1861602922 — MRS. SARAH M. GUIDORZI MSW, LCSW
Practice Location Address:

10004 KENNERLY RD STE 280B
SAINT LOUIS, MO
63128-2177

Practice Phone: 314-525-7296
Practice Fax: 314-525-7260

1164692729 — SOUTH COUNTY ORTHOPEDICS AND SPORTS MEDICINE INC
Practice Location Address:

10004 KENNERLY RD STE 274B
SAINT LOUIS, MO
63128-2177

Practice Phone: 314-849-7979
Practice Fax: 314-849-3555

Directions to “ DR. DEEPU SUDHAKARAN M.D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.