Dr. Kalugotla N Shivaram
Emergency Physician Pediatric Emergency Physician
1111 W Pearce Blvd
Wentzville
, Missouri 63385-1020
Dr. Kalugotla N Shivaram
Emergency Physician Pediatric Emergency Physician
1111 W Pearce Blvd
Wentzville
, Missouri 63385-1020
(636) 887-4288
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About
Features
Specialties
- Emergency Physician
- Pediatric Emergency Physician
Languages spoken
- English
Location
First Address
- Dr. Kalugotla N Shivaram
- 842 Bellerive Manor Dr
- Creve Coeur, MO
- Zip : 63141-3201
- Phone : (636) 887-4288
Second Address
- Dr. Kalugotla N Shivaram
- 1111 W Pearce Blvd
- Wentzville, MO
- Zip : 63385-1020
- Fax : (636) 639-2368
- Phone : (636) 887-4288
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207P00000X | Emergency Physician | 036086751 | IL |
| Y | 207P00000X | Emergency Physician | 111383 | MO |
| N | 207PP0204X | Pediatric Emergency Physician | 111383 | MO |
National Provider Identifier
| NPI | 1619959137 |
|---|---|
| Provider Name | Dr. Kalugotla N Shivaram |
| First Address | Creve Coeur, MO 63141-3201 |
| Second Address | Wentzville, MO 63385-1020 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/11/2005 |
| Last Update Date | 05/05/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036086751 | (05) | IL |
| 207245606 | (05) | MO |
| G10371 | (02) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.