Individual
DR. SREENIVASULU BOGACHENCHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 US HIGHWAY 61, FESTUS, MO 63028-4100
(636) 933-5337
Mailing address
1400 US HIGHWAY 61, FESTUS, MO 63028-4100
(636) 933-5337
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036125603
IL
207R00000X
Internal Medicine Physician
Primary
2016010622
MO
208M00000X
Hospitalist Physician
036125603
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TBD
—
IL
Enumeration date
05/12/2010
Last updated
03/01/2022
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