Organization
GATEWAY GERIATRIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAILAJA PULISETTY M.D. (PHYSICIAN/PRESIDENT)
(314) 225-6015
Entity
Organization
Contact information
Practice address
12026 CONWAY RD, SAINT LOUIS, MO 63131-2417
(314) 225-6015
Mailing address
12026 CONWAY RD, SAINT LOUIS, MO 63131-2417
(314) 225-6015
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
2005019644
MO
Other
Enumeration date
05/05/2011
Last updated
07/13/2011
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