Provider Demographics
NPI:1659869857
Name:VVASUDEVAN LLC
Entity Type:Organization
Organization Name:VVASUDEVAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:N
Authorized Official - Last Name:VASUDEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-206-6022
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63302-0173
Mailing Address - Country:US
Mailing Address - Phone:314-952-8009
Mailing Address - Fax:888-511-1238
Practice Address - Street 1:5401 VETERANS MEMORIAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1687
Practice Address - Country:US
Practice Address - Phone:636-206-6022
Practice Address - Fax:780-328-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty