Dr Shesha Kalyan Katakam, MD, MPH | |
3878 Pershall Rd, Ferguson, MO 63135-1246 | |
(314) 839-7500 | |
Not Available |
Full Name | Dr Shesha Kalyan Katakam |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 3878 Pershall Rd, Ferguson, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1578720439 | NPI | - | NPPES |
000000833441 | Other | IN | ANTHEM BCBS |
151020017 | Other | IN | MEDICARE PTAN |
201188170 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | MD.202228 (Louisiana) | Secondary |
208000000X | Pediatrics | 01073004A (Indiana) | Primary |
Entity Name | Indiana University Health La Porte Physicians Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1760593776 PECOS PAC ID: 0345147963 Enrollment ID: O20031212000670 |
Mailing Address | Practice Location Address |
---|---|
Dr Shesha Kalyan Katakam, MD, MPH 1509 State St, La Porte, IN 46350-3115 Ph: (219) 324-3431 | Dr Shesha Kalyan Katakam, MD, MPH 3878 Pershall Rd, Ferguson, MO 63135-1246 Ph: (314) 839-7500 |
Dr. April L. Tyus-myles, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3878 Pershall Rd, Ferguson, MO 63135 Phone: 314-839-7500 Fax: 314-839-8545 | |
Erica Harris-herron, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3878 Pershall Rd, Ferguson, MO 63135 Phone: 314-839-7500 | |
Laura Elizabeth Holzum, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 3878 Pershall Rd, Ferguson, MO 63135 Phone: 314-839-7500 |