Provider Demographics
NPI:1417960634
Name:CHATHADI, KRISHNAVEL V (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNAVEL
Middle Name:V
Last Name:CHATHADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-7644
Mailing Address - Fax:314-996-7658
Practice Address - Street 1:12855 N 40 DR
Practice Address - Street 2:STE 175
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8657
Practice Address - Country:US
Practice Address - Phone:866-236-5566
Practice Address - Fax:314-628-9696
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO42387207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21387508Medicaid
CO800368Medicare ID - Type Unspecified
CO21387508Medicaid