Konala, Sivasankara R
Konala, Sivasankara R is an individual health care provider with primary practice located at 1111 W Pearce Blvd , Wentzville MO 63385-1020. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Konala, Sivasankara R can be contacted via phone (636) 887-4288.Contact Information
Primary practice address
1111 W Pearce Blvd
Wentzville MO 63385-1020
Phone: (636) 887-4288
Fax: (636) 639-2368
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 1083988 | Missouri |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 108398 | Missouri |
Profile Details
| NPI number | 1538104229 |
|---|---|
| LBN Legal business name | Konala, Sivasankara R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 18th, 2006 |
| Last updated | May 21st, 2019 - about 5 years 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 | 1538104229 | NPPES |
| Missouri | MEDICAID | 204888713 |
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