Organization
ID CONSULTANTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHANDRA B. DOMMARAJU M.D. (PRESIDENT)
(636) 933-2344
Entity
Organization
Contact information
Practice address
1400 US HIGHWAY 61 STE 260, FESTUS, MO 63028-4101
(636) 933-2344
(636) 937-9031
Mailing address
1400 US HIGHWAY 61 STE 260, FESTUS, MO 63028-4101
(636) 933-2344
(636) 937-9031
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MO106962
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578866596
NPI
MO
Enumeration date
09/13/2006
Last updated
04/26/2021
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