Individual
DR. MADHU KALYAN PENDURTHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS MPH, MD
Contact information
Practice address
1229 E SEMINOLE ST, SPRINGFIELD, MO 65804-2227
(417) 888-5696
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(855) 420-7900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
6620
NE
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
2016039967
MO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
BP10048662
TX
207RP1001X
Pulmonary Disease Physician
Primary
2016039967
MO
207RP1001X
Pulmonary Disease Physician
BP10048662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE
MO
05
—
PENDING
—
AR
05
—
PENDING
—
MO
05
—
PENDING
—
OK
Enumeration date
08/29/2011
Last updated
07/21/2022
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