Individual
SRI DEVI KOLLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1011 BOWLES AVE, STE 450, FENTON, MO 63026-2395
(314) 467-1500
(314) 467-1515
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 467-1500
(314) 467-1515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
109530
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100568
BLUE CROSS & BLUE SHIELD
MO
05
—
208626804
—
MO
01
—
P00074510
RAILROAD MEDICARE
MO
Enumeration date
06/01/2006
Last updated
02/14/2017
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