Healthcare Provider Details

I. General information

NPI: 1063886851
Provider Name (Legal Business Name): GASTROENTEROLOGY AND LIVER CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MAIN ST
FESTUS MO
63028-1800
US

IV. Provider business mailing address

PO BOX 31385
SAINT LOUIS MO
63131-0385
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-2320
  • Fax: 636-937-9693
Mailing address:
  • Phone: 636-931-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36128913
License Number StateIL

VIII. Authorized Official

Name: NAEEM ASLAM
Title or Position: PRESIDENT
Credential: MD
Phone: 636-931-2320