| Madhuram Llc | |
|
3915 Watson Rd Ste 100 Saint Louis MO 63109-1251 | |
| (314) 881-0300 | |
| Not Available |
| Full Name | Madhuram Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3915 Watson Rd Ste 100, Saint Louis, Missouri |
| Authorized Official Name and Position | Kamlesh Vyas (OWNER) |
| Authorized Official Contact | 3148810300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madhuram Llc 2168 White Lane Dr Chesterfield MO 63017-7947 Ph: () - | Madhuram Llc 3915 Watson Rd Ste 100 Saint Louis MO 63109-1251 Ph: (314) 881-0300 |
| NPI Number | 1144899162 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 06/23/2021 |
| Medicare PECOS PAC ID | 3072911825 |
|---|---|
| Medicare Enrollment ID | O20211007002631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144899162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kamlesh C Vyas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679551378 PECOS PAC ID: 3173540366 Enrollment ID: I20051027000301 |
| Provider Name | Allison Dolan-boschert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659922946 PECOS PAC ID: 4587096391 Enrollment ID: I20191118000077 |
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