Individual
MR. SRINIVASAN RAGHAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12700 SOUTHFORK ROAD, SUITE 220, SAINT LOUIS, MO 63128-2106
(314) 543-5942
(314) 543-5947
Mailing address
12700 SOUTHFORK RD, STE 220, SAINT LOUIS, MO 63128-3201
(314) 543-5942
(314) 543-5947
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2000143921
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204965008
—
MO
Enumeration date
08/13/2006
Last updated
03/14/2017
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