Provider Demographics
NPI:1720475403
Name:KUNDUMADAM, SHANKER DAS (MD)
Entity type:Individual
Prefix:MR
First Name:SHANKER DAS
Middle Name:
Last Name:KUNDUMADAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 US HIGHWAY 61 STE N3300
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4137
Mailing Address - Country:US
Mailing Address - Phone:636-937-8675
Mailing Address - Fax:636-933-1981
Practice Address - Street 1:1390 US HIGHWAY 61 STE N3300
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4137
Practice Address - Country:US
Practice Address - Phone:636-937-8675
Practice Address - Fax:636-933-1981
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2025-08-29
Deactivation Date:2015-11-24
Deactivation Code:
Reactivation Date:2015-12-22
Provider Licenses
StateLicense IDTaxonomies
IAMD-49141207RG0100X
MO2024046631207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology