Individual
LATHA MYLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11133 DUNN RD STE 2427, SAINT LOUIS, MO 63136-6163
(314) 653-5643
(314) 653-5648
Mailing address
11133 DUNN RD STE 2427, SAINT LOUIS, MO 63136-6163
(314) 653-5643
(314) 653-5648
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2001014849
MO
208M00000X
Hospitalist Physician
Primary
2001014849
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972576890
—
IL
05
—
205328701
—
MO
Enumeration date
02/10/2006
Last updated
02/19/2021
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