Individual
DR. SHIVARAJAN MANICKAVASAGAM AMUDHAVALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.B.B.S.
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Mailing address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
201029319
MO
208000000X
Pediatrics Physician
P23802
MD
Other
Enumeration date
12/05/2008
Last updated
10/26/2012
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