| Bodavula Md Llc | |
|
709 Turrentine Trl Creve Coeur MO 63141-6089 | |
| (914) 563-2943 | |
| Not Available |
| Full Name | Bodavula Md Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 709 Turrentine Trl, Creve Coeur, Missouri |
| Authorized Official Name and Position | Venkata Kr Bodavula (SURGEON) |
| Authorized Official Contact | 9145632943 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bodavula Md Llc 709 Turrentine Trl Creve Coeur MO 63141-6089 Ph: (914) 563-2943 | Bodavula Md Llc 709 Turrentine Trl Creve Coeur MO 63141-6089 Ph: (914) 563-2943 |
| NPI Number | 1790183077 |
|---|---|
| Provider Enumeration Date | 12/18/2014 |
| Last Update Date | 12/18/2014 |
| Medicare PECOS PAC ID | 4587983697 |
|---|---|
| Medicare Enrollment ID | O20150512000091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790183077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2010007564 (Missouri) | Primary |
| Provider Name | Venkata Krishna Rao Bodavula |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1275714784 PECOS PAC ID: 2961534334 Enrollment ID: I20100720001045 |
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