Individual
DR. SHESHA KALYAN KATAKAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
3878 PERSHALL RD, FERGUSON, MO 63135-1246
(314) 839-7500
Mailing address
1509 STATE ST, LA PORTE, IN 46350-3115
(219) 324-3431
(219) 362-3802
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01073004A
IN
208000000X
Pediatrics Physician
MD.202228
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000833441
ANTHEM BCBS
IN
01
—
151020017
MEDICARE PTAN
IN
05
—
201188170
—
IN
Enumeration date
05/19/2008
Last updated
01/20/2023
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