Individual
SRIRAM VISSA
Active
Individual
SRIRAM VISSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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