Samudrala, Siresha Kiran
Samudrala, Siresha Kiran is an sole proprietor health care provider with primary practice located at 1 Jefferson Barracks Rd , Saint Louis MO 63125-4181. She recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as her primary health care specialty. Samudrala, Siresha Kiran can be contacted via phone (314) 289-6314.Contact Information
Primary practice address
1 Jefferson Barracks Rd
Saint Louis MO 63125-4181
Phone: (314) 289-6314
Fax: (314) 289-7037
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation | 208100000X | 2003001132 | Missouri |
Profile Details
| NPI number | 1700840790 |
|---|---|
| LBN Legal business name | Samudrala, Siresha Kiran |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 14th, 2006 |
| Last updated | Mar 19th, 2024 - about last year |
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 | 1700840790 | NPPES |
| Missouri | MEDICAID | 208749903 |
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