Organization
SOUTHSIDE MEDICAL GROUP PC
Active
Organization
SOUTHSIDE MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUBODH K MEHRA M.D. (DOCTOR)
(314) 638-9100
Entity
Organization
Contact information
Practice address
9700 MACKENZIE RD STE 105, SAINT LOUIS, MO 63123-5423
(314) 638-9100
Mailing address
9700 MACKENZIE RD STE 105, SAINT LOUIS, MO 63123-5423
(314) 638-9100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R77046
MO
Other
Enumeration date
06/11/2007
Last updated
08/28/2009
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