Provider Demographics
NPI:1649204173
Name:PATRI, MANOKIRAN (MD)
Entity type:Individual
Prefix:DR
First Name:MANOKIRAN
Middle Name:
Last Name:PATRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANOKIRAN
Other - Middle Name:
Other - Last Name:BUDDHIRAJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 504934
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 1ST CAPITOL DR STE 260
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2888
Practice Address - Country:US
Practice Address - Phone:636-925-0900
Practice Address - Fax:636-925-0960
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104049174400000X
MO2009027341207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-104049OtherMEDICAL LICENSE NUMBER
ILK05358OtherSTATE NUMBER
ILBB7424043OtherDEA
ILBH42465Medicare UPIN