Individual
KRISHNAMRAJU KOSURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
3126 S JACKSON AVE, SUITE 100, JOPLIN, MO 64804-2534
(417) 556-3416
(417) 556-3417
Mailing address
PO BOX 504944, SAINT LOUIS, MO 63150-4944
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0437804
KS
208000000X
Pediatrics Physician
Primary
2015040888
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013204296
—
MO
05
—
200622340A
—
OK
05
—
PENDING
—
KS
Enumeration date
07/07/2011
Last updated
01/14/2016
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