| Dr Shesha Kalyan Katakam, MD, MPH | |
|
3878 Pershall Rd, Ferguson, MO 63135-1246 | |
| (314) 839-7500 | |
| Not Available |
| Full Name | Dr Shesha Kalyan Katakam |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 3878 Pershall Rd, Ferguson, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578720439 | NPI | - | NPPES |
| 000000833441 | Other | IN | ANTHEM BCBS |
| 151020017 | Other | IN | MEDICARE PTAN |
| 201188170 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | MD.202228 (Louisiana) | Secondary |
| 208000000X | Pediatrics | 01073004A (Indiana) | Primary |
| Entity Name | Ssm Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1700966207 PECOS PAC ID: 6608776299 Enrollment ID: O20040729001034 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Shesha Kalyan Katakam, MD, MPH 1509 State St, La Porte, IN 46350-3115 Ph: (219) 324-3431 | Dr Shesha Kalyan Katakam, MD, MPH 3878 Pershall Rd, Ferguson, MO 63135-1246 Ph: (314) 839-7500 |
Dr. April L. Tyus-myles, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3878 Pershall Rd, Ferguson, MO 63135 Phone: 314-839-7500 Fax: 314-839-8545 | |
Erica Harris-herron, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3878 Pershall Rd, Ferguson, MO 63135 Phone: 314-839-7500 | |
Laura Elizabeth Holzum, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 3878 Pershall Rd, Ferguson, MO 63135 Phone: 314-839-7500 |