Healthcare Provider Details

I. General information

NPI: 1497774673
Provider Name (Legal Business Name): WEST FLORISSANT INTERNISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MCKELVEY RD STE 100
BRIDGETON MO
63044
US

IV. Provider business mailing address

3165 MCKELVEY RD STE 100
BRIDGETON MO
63044-2550
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-1333
  • Fax: 314-739-1350
Mailing address:
  • Phone: 314-739-1333
  • Fax: 147-391-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberRIE67
License Number StateMO

VIII. Authorized Official

Name: NAVEED RAZZAQUE
Title or Position: OWNER
Credential: M.D.
Phone: 314-837-1333