Individual
SRIRAM VISSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12303 DE PAUL DR, BRIDGETON, MO 63044-2512
(314) 317-0600
(314) 317-0606
Mailing address
12101 WOODCREST EXECUTIVE DR, SUITE 210, SAINT LOUIS, MO 63141-5047
(314) 317-0600
(314) 317-0606
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2004016757
MO
208M00000X
Hospitalist Physician
2004016757
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558334573
—
IL
05
—
209220003
—
MO
Enumeration date
02/09/2006
Last updated
06/19/2014
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