Boodram, Mitra B
Boodram, Mitra B is an individual health care provider with primary practice located at 11133 Dunn Rd Dept Radiology, Saint Louis MO 63136-6163. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Neuroradiology. Allopathic & Osteopathic Physicians / Neuroradiology is his primary health care specialty. Boodram, Mitra B can be contacted via phone (314) 362-7200.Contact Information
Primary practice address
11133 Dunn Rd Dept Radiology
Saint Louis MO 63136-6163
Phone: (314) 362-7200
Fax: (314) 747-4189
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 110362 | Missouri |
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | 110362 | Missouri |
Profile Details
| NPI number | 1174537039 |
|---|---|
| LBN Legal business name | Boodram, Mitra B |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 28th, 2006 |
| Last updated | Apr 25th, 2024 - about 7 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174537039 | NPPES |
| Missouri | MEDICAID | 208285007 |
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