Healthcare Provider Details

I. General information

NPI: 1538505250
Provider Name (Legal Business Name): DENIZ SARHADDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N OUTER 40 RD STE 300
CHESTERFIELD MO
63005-1364
US

IV. Provider business mailing address

17300 N OUTER 40 RD STE 300
CHESTERFIELD MO
63005-1364
US

V. Phone/Fax

Practice location:
  • Phone: 636-530-6161
  • Fax: 636-777-7500
Mailing address:
  • Phone: 636-530-6161
  • Fax: 636-777-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number81584
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS630139014790
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2020023232
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: