Individual
DR. KALUGOTLA N SHIVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 W PEARCE BLVD, WENTZVILLE, MO 63385-1020
(636) 887-4288
(636) 639-2368
Mailing address
842 BELLERIVE MANOR DR, CREVE COEUR, MO 63141-3201
(636) 887-4288
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036086751
IL
207P00000X
Emergency Medicine Physician
Primary
111383
MO
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
111383
MO
208000000X
Pediatrics Physician
111383
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086751
—
IL
05
—
207245606
—
MO
Enumeration date
11/18/2005
Last updated
10/06/2023
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