Mirdhula Ananthamurugan, MD
Individual provider Active NPI Family Medicine Physician · Saint Louis, MO
NPI 1437944014 · NPPES record last updated Jul 6, 2025
Key facts
- NPI
- 1437944014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2025022950 (MO)
- Practice address
- 12680 Olive Blvd Ste 300
Saint Louis, MO 63141-6322 - Phone
- (314) 251-8888
- Fax
- (314) 251-8889
- NPI assigned
- Apr 14, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250716003023 | MO | Order and Referring Only - Family Practice |
9638684772 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2025022950 | MO | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 2025022950 | MO | Yes |
Addresses
Primary practice location
12680 Olive Blvd Ste 300
Saint Louis, MO 63141-6322
Mailing address
12680 Olive Blvd Ste 300
Saint Louis, MO 63141-6322
Phone (314) 251-8888
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All providers in Saint Louis, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.