Basic Information
| Provider Information | |||||||||
| NPI: | 1184741860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MELKAVERI | ||||||||
| FirstName: | SONIANAGARAJ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153775603 | ||||||||
| FaxNumber: | 6152905191 | ||||||||
| Practice Location | |||||||||
| Address1: | 12303 DEPAUL DR | ||||||||
| Address2: | |||||||||
| City: | BRIDGETON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143170600 | ||||||||
| FaxNumber: | 3143170606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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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 | 208M00000X | 2007002168 | MO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 2007002168 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1184741860 | 05 | IL | MEDICAID | 207317405 | 05 | MO | MEDICAID |