# BODAVULA MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790183077
- **Authorized official:** DR. VENKATA KR BODAVULA MD (SURGEON)
- **Authorized official phone:** (914) 563-2943

## Contact information

- **Practice address:** 709 TURRENTINE TRL, CREVE COEUR, MO 63141-6089
- **Practice address phone:** (914) 563-2943
- **Mailing address:** 709 TURRENTINE TRL, CREVE COEUR, MO 63141-6089
- **Mailing address phone:** (914) 563-2943

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 2010007564 | MO | Yes |

## Other

- **Enumeration date:** 12/18/2014
- **Last updated:** 12/18/2014