Individual
MADHAVI KANDULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
845 NORTH NEW BALLAS COURT, SUITE 310, ST LOUIS, MO 63141-7148
(314) 692-0221
(314) 692-0686
Mailing address
845 NORTH NEW BALLAS COURT, SUITE 310, ST LOUIS, MO 63141-7148
(314) 692-0221
(314) 692-0686
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
R8J49
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177308
BCBSMO
—
01
—
199611384014
HUMANA
—
Enumeration date
10/11/2006
Last updated
07/08/2007
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