Organization
BODAVULA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VENKATA KR BODAVULA MD (SURGEON)
(914) 563-2943
Entity
Organization
Contact information
Practice address
709 TURRENTINE TRL, CREVE COEUR, MO 63141-6089
(914) 563-2943
Mailing address
709 TURRENTINE TRL, CREVE COEUR, MO 63141-6089
(914) 563-2943
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2010007564
MO
Other
Enumeration date
12/18/2014
Last updated
12/18/2014
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