Individual
SIRESHA KIRAN SAMUDRALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 JEFFERSON BARRACKS RD, SAINT LOUIS, MO 63125-4181
(314) 289-6314
(314) 289-7037
Mailing address
1 JEFFERSON BARRACKS RD, SAINT LOUIS, MO 63125-4181
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2003001132
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208749903
—
MO
Enumeration date
04/14/2006
Last updated
12/23/2025
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