Individual
DR. DEEPU SUDHAKARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
10004 KENNERLY RD STE 295B, SAINT LOUIS, MO 63128-2177
(314) 500-2424
Mailing address
PO BOX 854, MARION, IL 62959-0854
(618) 993-1400
(618) 993-1522
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036127430
IL
208600000X
Surgery Physician
Primary
2015033187
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036127430
—
IL
05
—
200097157
—
MO
Enumeration date
05/30/2007
Last updated
03/28/2024
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