DR. MITRA B BOODRAM (NPI# 1174537039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174537039 |
| Entity Type | Individual |
| Full Name | DR. MITRA B BOODRAM |
| Credential | MD |
| Practice Address |
11133 Dunn Rd Saint Louis MO 63136-6163 |
| Mailing Address |
660 S Euclid Ave Cb 8131 Saint Louis MO 63110-1010 |
| Practice Telephone | 3143627200 |
| Practice Fax Number | 3147474189 |
| Mailing Telephone | 3143627200 |
| Mailing Fax Number | 3147474189 |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2019-12-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085N0700X |
Radiology Specialization: Neuroradiology |
110362 | MO | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
110362 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 208285007 | 05 |
| Street Address |
11133 DUNN RD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63136-6163 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659376390 | John Oldham | Emergency Medicine | 11133 Dunn Rd, Rm H2241, Saint Louis, MO 63136-6119 | 2005-06-18 |
| 1750988499 | Lindsey Onate | Dietitian, Registered | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-10-06 |
| 1548878705 | Christian Hospital Northeast Northwest | Clinical Medical Laboratory | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-07-14 |
| 1962028555 | Wayne Joseph Parks | Spec/Tech, Pathology | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-06-19 |
| 1295368504 | Rebecca Lynne Mooshegian Brewer | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2020-02-14 |
| 1114568821 | Kelly Ann Blanner | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2019-10-03 |
| 1235790957 | Kelly Anderson Erlinger | Anesthesiologist Assistant | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2019-06-24 |
| 1053896654 | Hermance Fortune | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2018-09-28 |
| 1801376884 | Andrea Lynn Thurm | Nurse Practitioner | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2018-08-18 |
| 1831675545 | Kyle Patrick Mclafferty | Physician Assistant | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2018-07-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518565993 | Dorothy Smith | Home Health | 2531 Nathan Drive, St Louis, MO 63136 | 2020-10-16 |
| 1538784459 | Rita D Wilson | Technician | 9597 Jacobi Ave Bldg 33 Apt 7, Saint Louis, MO 63136 | 2020-06-16 |
| 1922646728 | Eduhealth Personal Care Services | Technician | 5843 Eagle Valley Dr Saint Louis Mo 63136, Saint Louis, MO 63136 | 2019-12-12 |
| 1558912964 | Homers Haven Home Care LLC | Home Health | 5636 Pamplin Pl, St Louis, MO 63136 | 2019-09-26 |
| 1366096703 | Chloe Suzanne Datillo | Nurse Practitioner | 2865 Netherton Dr., St Louis, MO 63136 | 2019-07-24 |
| 1053976431 | U Auto Be Quik LLC | Non-emergency Medical Transport (VAN) | 10352 Castle Drive, St. Louis, MO 63136 | 2019-05-01 |
| 1164945895 | A Plus Home Health Services LLC | Home Health | 9517 Wilson Bridge Drive, Saint Louis, MO 63136 | 2017-07-25 |
| 1184150302 | Fairview Village Adult Day Care LLC | Clinic/Center | 8449 Jennings Station Rd, Fairview Village Adult Day Care, Saint Louis, MO 63136 | 2017-05-08 |
| 1023541182 | Lots of Love Home Health Services | In Home Supportive Care | 4144 Lindell Blvd. Suite 218, Saint Louis, MO 63136 | 2017-04-06 |
| 1912440876 | Carestl Health | Clinic/Center | 7047 Emma Ave, Jennings, MO 63136 | 2016-11-28 |
| Find all providers in zip 63136 | ||||
| Taxonomy Code | 2085N0700X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Neuroradiology |
| A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457832404 | Sudhir Bhimaniya | Radiology | 216 S Kingshighway Blvd, Saint Louis, MO 63110-1026 | 2018-08-28 |
| 1902293285 | Kasra Rahbar | Radiology | 510 S Kingshighway Blvd, Dept Radiology, Saint Louis, MO 63110-1016 | 2015-04-23 |
| 1275947012 | Rahul Pradeep Deolankar | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2014-06-19 |
| 1073923223 | John Td Vu | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2014-04-28 |
| 1952663270 | Rami W Eldaya | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2012-06-12 |
| 1992064521 | Ritu Bordia | Radiology | 1201 S Grand Blvd, Saint Louis, MO 63104-1016 | 2012-05-16 |
| 1093026064 | Ali Yusuf Mian | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2010-06-24 |
| 1083925085 | Gerald Johnstone Palagallo | Radiology | 615 S New Ballas Rd, Saint Louis, MO 63141-8221 | 2010-06-24 |
| 1851602965 | Taylor John Greenwood | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2010-06-24 |
| 1881822682 | Akash P Kansagra | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2009-06-30 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63136 |
Please comment or provide details below to improve the information on DR. MITRA B BOODRAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.