Provider Demographics
NPI:1225494628
Name:INFECTIOUS DISEASE
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-487-8724
Mailing Address - Street 1:842 N NEW BALLAS CT UNIT 206
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7153
Mailing Address - Country:US
Mailing Address - Phone:314-487-8724
Mailing Address - Fax:
Practice Address - Street 1:4530 LEMAY FERRY RD
Practice Address - Street 2:SUITE M
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1600
Practice Address - Country:US
Practice Address - Phone:314-487-8724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108767207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty