Individual
DR. ANIL KUMAR SRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12266 DE PAUL DR STE 305, BRIDGETON, MO 63044-2514
(314) 770-0991
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-090872
IL
208600000X
Surgery Physician
Primary
2004034166
MO
2086S0102X
Surgical Critical Care Physician
2004034166
MO
2086S0127X
Trauma Surgery Physician
2004034166
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205920220
—
MO
01
—
2004034166
LICENSE
MO
01
—
927594382
MEDICARE PTAN
MO
Enumeration date
10/03/2006
Last updated
03/07/2023
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