Organization
INFECTIOUS DISEASE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SURESH NELLORE MD (AUTHORIZE OFFICIAL)
(314) 729-1570
Entity
Organization
Contact information
Practice address
10004 KENNERLY RD, SUITE 368B, SAINT LOUIS, MO 63128-2141
(314) 729-1570
(314) 729-1575
Mailing address
1836 LACKLAND HILL PKWY, ATTN: CREDENTIALING, SAINT LOUIS, MO 63146-3572
(314) 872-1439
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207RI0200X
Infectious Disease Physician
Primary
—
—
364SA2100X
Acute Care Clinical Nurse Specialist
—
—
Other
Enumeration date
10/22/2007
Last updated
02/18/2008
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