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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
(816) 302-9939
Mailing address
2401 GILLHAM RD, ATTN: PROVIDER ENROLLMENT DEPT, KANSAS CITY, MO 64108-4619
(816) 234-3000
(816) 302-9939

Taxonomy

Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
0436759
KS
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
201029319
MO
208000000X
Pediatrics Physician
P23802
MD

Other

Enumeration date
12/05/2008
Last updated
07/18/2026
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