Individual
PRAVEEN SRISATYA NIMMAGADDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5300 ARSENAL ST, SAINT LOUIS, MO 63139-1463
(314) 877-5989
Mailing address
5300 ARSENAL ST, SAINT LOUIS, MO 63139-1463
(314) 877-5989
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
107580
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107580
MEDICAL LICENSE NUMBER
MO
05
—
208484105
—
MO
Enumeration date
01/05/2007
Last updated
01/30/2015
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