MEDICARE: KIRUBAHARA VAHEESAN 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	2085R0204X	Vascular & Interventional Radiology Physician	2011-01362	NC
2	2085R0204X	Vascular & Interventional Radiology Physician	2012038839	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	:	1982891271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRUBAHARA VAHEESAN MD

Provider Business Mailing Address
First Line	:	641 N NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6713
Country	:	US
Telephone Number	:	314-888-4647
Fax Number	:	314-514-4014

Provider Business Practice Location Address
First Line	:	641 N NEW BALLAS RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6713
Country	:	US
Telephone Number	:	314-888-4647
Fax Number	:

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	01/15/2026

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Directions to “ KIRUBAHARA VAHEESAN MD” Practice Location

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