Individual
PRASAD V KANDULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4600 MEMORIAL DR STE W1, BELLEVILLE, IL 62226-5359
(618) 233-3066
Mailing address
3 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1281
(618) 233-6044
(618) 233-5195
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036086651
IL
207RI0011X
Interventional Cardiology Physician
Primary
036086651
IL
207UN0901X
Nuclear Cardiology Physician
036086651
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086651
—
IL
05
—
1164518460
—
IL
Enumeration date
10/05/2006
Last updated
12/29/2025
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