Basic Information
| Provider Information | |||||||||
| NPI: | 1740400886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAIDU | ||||||||
| FirstName: | RAJYALAKSHMI | ||||||||
| MiddleName: | GONUGUNTLA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12541 CONWAY DOWNS DRIVE | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 63141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145767114 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6420 CLAYTON RD | ||||||||
| Address2: | ST MARYS HEALTH CENTER | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147688202 | ||||||||
| FaxNumber: | 3147687145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | R9756 | MO | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.