MEDICARE: RAMULU SAMUDRALA P.C

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	207W00000X	Ophthalmology Physician	R6643	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	:	1588628986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMULU SAMUDRALA P.C

Provider Business Mailing Address
First Line	:	11155 DUNN RD
Second Line	:	STE 206E
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6149
Country	:	US
Telephone Number	:	314-355-7880
Fax Number	:	314-355-8899

Provider Business Practice Location Address
First Line	:	11155 DUNN RD
Second Line	:	STE 206E
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6149
Country	:	US
Telephone Number	:	314-355-7880
Fax Number	:	314-355-8899

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	09/21/2017

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Directions to “ RAMULU SAMUDRALA P.C” Practice Location

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