Healthcare Provider Details

I. General information

NPI: 1578912572
Provider Name (Legal Business Name): AHMED EID SOBHY ABDELKADER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15740 S OUTER 40 RD
CHESTERFIELD MO
63017-2004
US

IV. Provider business mailing address

PO BOX 227
WILLOW SPRINGS IL
60480-0227
US

V. Phone/Fax

Practice location:
  • Phone: 636-237-4699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTP227
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number32256
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036158535
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: