| Doctor Name: | DR. NARSIMHA R MUDDASANI |
| NPI Number: | 1548366263 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 105499 |
| Business Practice Address: | 100 N 8th St East Saint Louis, IL - 622012989 |
| Business Phone Number: | 6182710130 |
| Business Fax Number: | 6182716325 |
| Mailing Address: | 2120 Madison Ave, Suite 406 GRANITE CITY |
| State: | IL |
| Postal Code: | 620404744 |
| Phone Number: | 6188771008 |
| Fax Number: | 6188771512 |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 01/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0804X |
| License Number: | 105499 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Child & Adolescent Psychiatry |
| Taxonomy Definition: | Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |