Healthcare Provider Details

I. General information

NPI: 1043848559
Provider Name (Legal Business Name): MUHANAD AHMED OMRAN BENSALEEM MD,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 US HIGHWAY 61 STE 2200N
FESTUS MO
63028-4121
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-7939
US

V. Phone/Fax

Practice location:
  • Phone: 314-467-3800
  • Fax:
Mailing address:
  • Phone: 314-467-3800
  • Fax: 636-933-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024025980
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: