Srivilasa, Charlie

Srivilasa, Charlie is an individual health care provider with primary practice located at 10012 Kennerly Rd Ste 406 , Saint Louis MO 63128-2197. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Trauma Surgery, Allopathic & Osteopathic Physicians / Surgical Critical Care. Allopathic & Osteopathic Physicians / Surgical Critical Care is his primary health care specialty. Srivilasa, Charlie can be contacted via phone (314) 525-1224.

Contact Information

Primary practice address
10012 Kennerly Rd Ste 406 Saint Louis MO 63128-2197
Phone: (314) 525-1224
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 2018032445 Missouri
Allopathic & Osteopathic Physicians / Trauma Surgery 2086S0127X 2018032445 Missouri
Allopathic & Osteopathic Physicians / Surgical Critical Care 2086S0102X 2018032445 Missouri

Profile Details

NPI number 1346531464
LBN Legal business name Srivilasa, Charlie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 23rd, 2011
Last updated May 24th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346531464 NPPES
Missouri MEDICAID 200066167

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