Provider Demographics
NPI:1275714784
Name:BODAVULA, VENKATA KR (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:KR
Last Name:BODAVULA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3394 MCKELVEY RD STE 115
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2531
Mailing Address - Country:US
Mailing Address - Phone:636-373-9882
Mailing Address - Fax:866-283-3416
Practice Address - Street 1:5600 MEXICO RD STE 21
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1660
Practice Address - Country:US
Practice Address - Phone:636-373-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20100075642086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand