Individual
KAVITHA KOSURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
607 S NEW BALLAS RD, SUITE 3300, SAINT LOUIS, MO 63141-8222
(314) 251-4400
(314) 251-6375
Mailing address
607 S NEW BALLAS RD, SUITE 3300, SAINT LOUIS, MO 63141-8222
(314) 251-4400
(314) 251-6375
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
34008023
OH
207RX0202X
Medical Oncology Physician
Primary
R6A19
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215981766
—
MO
05
—
26597070
—
OH
01
—
P01351475
RAILROAD MEDICARE
MO
Enumeration date
05/20/2006
Last updated
04/29/2015
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