Healthcare Provider Details

I. General information

NPI: 1659689495
Provider Name (Legal Business Name): NAZISH RIAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SAINT LUKES CENTER DR BLDG B
CHESTERFIELD MO
63017-3509
US

IV. Provider business mailing address

111 SAINT LUKES CENTER DR BLDG B
CHESTERFIELD MO
63017-3509
US

V. Phone/Fax

Practice location:
  • Phone: 636-685-7745
  • Fax:
Mailing address:
  • Phone: 516-526-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number2018012673
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number2018012673
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2018012673
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: