Vissa, Sriram
Vissa, Sriram is an individual health care provider with primary practice located at 12303 De Paul Dr , Bridgeton MO 63044-2512. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Vissa, Sriram can be contacted via phone (314) 317-0600.Contact Information
Primary practice address
12303 De Paul Dr
Bridgeton MO 63044-2512
Phone: (314) 317-0600
Fax: (314) 317-0606
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 2004016757 | Missouri |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 2004016757 | Missouri |
Profile Details
| NPI number | 1558334573 |
|---|---|
| LBN Legal business name | Vissa, Sriram |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 9th, 2006 |
| Last updated | Jun 19th, 2014 - about 10 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 | 1558334573 | NPPES |
| Missouri | MEDICAID | 209220003 | |
| Missouri | MEDICAID | 1558334573 |
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