Healthcare Provider Details

I. General information

NPI: 1649558289
Provider Name (Legal Business Name): SALMAN IFTIKHAR CHAUDHRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 GRAHAM RD DIV IM MEDICAL ONCOLOGY, STE 101
FLORISSANT MO
63031-8014
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-1171
  • Fax: 314-362-7086
Mailing address:
  • Phone: 314-747-1171
  • Fax: 314-362-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017031728
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2017031728
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: