Individual
DR. DEEPTHI BUSAYAVALASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6435 CHIPPEWA ST, SAINT LOUIS, MO 63109-2104
(314) 353-1870
Mailing address
6435 CHIPPEWA ST, SAINT LOUIS, MO 63109-2104
(314) 353-1870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125068035
IL
207RH0003X
Hematology & Oncology Physician
Primary
2019014568
MO
Other
Enumeration date
05/27/2016
Last updated
08/19/2022
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