Individual
DR. MITRA B BOODRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11133 DUNN RD, DEPT RADIOLOGY, SAINT LOUIS, MO 63136-6163
(314) 362-7200
(314) 747-4189
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-7200
(314) 747-4189
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
110362
MO
2085R0202X
Diagnostic Radiology Physician
110362
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208285007
—
MO
Enumeration date
07/28/2006
Last updated
04/15/2025
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