Healthcare Provider Details

I. General information

NPI: 1831416999
Provider Name (Legal Business Name): BEENISH ZEHRA ZAIDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 HIGHWAY 30
DITTMER MO
63023-1909
US

IV. Provider business mailing address

1748 MICHAELWOOD CT
SAINT CHARLES MO
63303-4657
US

V. Phone/Fax

Practice location:
  • Phone: 314-518-5130
  • Fax:
Mailing address:
  • Phone: 636-579-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number2019029012
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberR-10447
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD-45756
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number2019029012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: