Healthcare Provider Details

I. General information

NPI: 1487013512
Provider Name (Legal Business Name): AYMAN DAOUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SAINT LUKES CENTER DR STE 20B
CHESTERFIELD MO
63017-3509
US

IV. Provider business mailing address

1438 S GRAND BLVD
SAINT LOUIS MO
63104-1027
US

V. Phone/Fax

Practice location:
  • Phone: 636-685-7745
  • Fax: 314-576-8187
Mailing address:
  • Phone: 314-977-6082
  • Fax: 314-977-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number2017008339
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2017008339
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: