Healthcare Provider Details

I. General information

NPI: 1497082218
Provider Name (Legal Business Name): SAQUIB ANJUM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
CRYSTAL CTY MO
63028-4108
US

IV. Provider business mailing address

1400 US HIGHWAY 61
CRYSTAL CTY MO
63028-4108
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-5337
  • Fax: 636-933-5337
Mailing address:
  • Phone: 636-933-5337
  • Fax: 636-933-5337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2026035998
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME171033
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME171033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: