Individual
PRAJWAL BASANNA KERANALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 617-3749
Mailing address
105 SWEET CHERRY WAY, WILDWOOD, MO 63040-2146
(301) 728-9565
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MO
Other
Enumeration date
04/14/2023
Last updated
04/24/2023
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