Healthcare Provider Details

I. General information

NPI: 1245250968
Provider Name (Legal Business Name): MOHAMMAD ASIF QAISRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: M ASIF QAISRANI

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2023
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 STIFEL LANE DR
CHESTERFIELD MO
63017-8048
US

IV. Provider business mailing address

1721 STIFEL LANE DR
CHESTERFIELD MO
63017-8048
US

V. Phone/Fax

Practice location:
  • Phone: 314-439-9033
  • Fax: 314-206-3992
Mailing address:
  • Phone: 314-439-9033
  • Fax: 314-206-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2000169534
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: