Healthcare Provider Details

I. General information

NPI: 1073772604
Provider Name (Legal Business Name): FRASAT CHAUDHRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD 400 EAST
CHESTERFIELD MO
63017-3417
US

IV. Provider business mailing address

232 S WOODS MILL RD 400 EAST
CHESTERFIELD MO
63017-3417
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-2888
  • Fax: 314-576-8167
Mailing address:
  • Phone: 314-878-2888
  • Fax: 314-576-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036118636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: