Individual
DR. PRATIBHA NAGENHALLI GURUSIDDAIYA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1 JEFFERSON BARRACKS DR, SAINT LOUIS, MO 63125-4181
(314) 894-6552
(314) 845-5073
Mailing address
850 BELLERIVE MANOR DR, SAINT LOUIS, MO 63141-3201
(314) 453-0650
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
113455
MO
Other
Enumeration date
05/17/2006
Last updated
07/08/2007
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