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NPI Code Detail

MEDICARE: ROOHI SIRAJ M.D.

MEDICARE: ROOHI SIRAJ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QG0300XGeriatric Medicine (Family Medicine) Physician2020011597MO
2207QG0300XGeriatric Medicine (Family Medicine) Physician036153866IL

General Provider Information

NPI Number : 1760885693
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROOHI SIRAJ M.D.
Provider Business Mailing Address
First Line : 4315 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5342
Country : US
Telephone Number : 618-767-7023
Fax Number :
Provider Business Practice Location Address
First Line : 4315 MEMORIAL DR
Second Line :
City : BELLEVILLE
State : IL
Zip : 62226-5342
Country : US
Telephone Number : 618-767-7023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2014
Last Update Date : 04/19/2023

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