Healthcare Provider Details

I. General information

NPI: 1225145691
Provider Name (Legal Business Name): NAVEED RAZZAQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
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: 314-739-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR1E67
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: