Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2021036903 | MO |
N | 207V00000X | Obstetrician & Gynecologist | 5101020883 | MI |
Y | 207VX0201X | Gynecologic Oncologist | 2021036903 | MO |
NPI | 1255751970 |
---|---|
Provider Name | Dr. Madhavi Manyam |
First Address | Saint Louis, MO 63141-8221 |
Second Address | Saint Louis, MO 63141-8221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 24/09/2021 |