Healthcare Provider Details

I. General information

NPI: 1629641881
Provider Name (Legal Business Name): QAMAR MOHAMMAD HUSSEIN AL TINAWI MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S 3RD ST STE 200
BELLEVILLE IL
62220-1952
US

IV. Provider business mailing address

15247 KINGSMAN CIR
CHESTERFIELD MO
63017-7412
US

V. Phone/Fax

Practice location:
  • Phone: 531-239-6564
  • Fax:
Mailing address:
  • Phone: 531-239-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9155
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2024018748
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036.177671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: