Provider Demographics
NPI:1811259179
Name:KALYAM, KRISHNA PRIYA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:PRIYA
Last Name:KALYAM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8096
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3937
Mailing Address - Fax:314-362-3725
Practice Address - Street 1:4901 FOREST PARK AVE FL 6
Practice Address - Street 2:6TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1402
Practice Address - Country:US
Practice Address - Phone:314-362-3937
Practice Address - Fax:314-362-3725
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2018-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2016011405207W00000X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO1811259179Medicaid