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Contact Information

KALUGOTLA N SHIVARAM, MD
1111 W PEARCE BLVD
WENTZVILLE, MO63385-1020
 Phone: 636-887-4288
 Fax: 636-639-2368
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
 

Pediatric Emergency Medicine

207PP0204X 93 Physician/Emergency Medicine
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for KALUGOTLA N SHIVARAM · (Male)

NPI # 1619959137
Status Active
Credentials MD
Entity Individual
Enumeration date 11/18/2005
Last updated 10/06/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036086751
  • MO License # 111383
  • IL Medicaid 036086751
  • MO Medicaid 207245606
Hospital affiliation(s)
  • CHRISTIAN HOSPITAL NORTHEAST - (Acute Care)
    11133 DUNN ROAD
    SAINT LOUIS, MO 63136
  • SAINT ANTHONY'S HEALTH CENTER - (Acute Care)
    ST ANTHONY'S WAY
    ALTON, IL 62002
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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