Healthcare Provider Details

I. General information

NPI: 1356827182
Provider Name (Legal Business Name): SAMEED KHALID LODHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 GRAHAM RD STE 1
FLORISSANT MO
63031-8018
US

IV. Provider business mailing address

1265 GRAHAM RD STE 1
FLORISSANT MO
63031-8018
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-1600
  • Fax: 314-741-1677
Mailing address:
  • Phone: 314-741-1600
  • Fax: 314-741-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.072617
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberRTL21-0071
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2022049889
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: