Provider Demographics
NPI:1972522092
Name:SRIDHAR, KOLLIPARA (MD)
Entity Type:Individual
Prefix:DR
First Name:KOLLIPARA
Middle Name:
Last Name:SRIDHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 FORSYTH BLVD
Mailing Address - Street 2:C B 8221
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2171
Mailing Address - Country:US
Mailing Address - Phone:314-362-6973
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-6973
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006000673207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201390507Medicaid
IL$$$$$$$$$Medicaid
I58042Medicare UPIN
MO201390507Medicaid
P00635770Medicare PIN