Healthcare Provider Details

I. General information

NPI: 1255394086
Provider Name (Legal Business Name): S AND M BAIG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HARBOR BEND CT SUITE 202
LAKE ST LOUIS MO
63367-1488
US

IV. Provider business mailing address

2 HARBOR BEND CT SUITE 202
LAKE ST LOUIS MO
63367-1478
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-2220
  • Fax: 636-625-4723
Mailing address:
  • Phone: 636-561-2220
  • Fax: 636-625-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number36225
License Number StateMO

VIII. Authorized Official

Name: MAIMUNA BAIG
Title or Position: PHYSICIAN
Credential: MD
Phone: 636-561-2220