Provider Demographics
NPI:1861417313
Name:ATLURI, SUDHEER C (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHEER
Middle Name:C
Last Name:ATLURI
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 1:1742 CARMAN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5871
Mailing Address - Country:US
Mailing Address - Phone:636-230-6044
Mailing Address - Fax:636-527-6862
Practice Address - Street 1:1111 W. PEARCE BLVD.
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1020
Practice Address - Country:US
Practice Address - Phone:636-887-4288
Practice Address - Fax:636-639-2368
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100503207P00000X
MOMD100503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204624217Medicaid
MO204624217Medicaid
MO938805009Medicare PIN
MOG07616Medicare UPIN
MO938805439Medicare PIN
MO204624217Medicaid
MO938804740Medicare PIN