Healthcare Provider Details

I. General information

NPI: 1548258684
Provider Name (Legal Business Name): GIHAN A KADER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ SUITE 103
LAKE ST LOUIS MO
63367-1380
US

IV. Provider business mailing address

7538 BUCKINGHAM DR
SAINT LOUIS MO
63105-2802
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-0206
  • Fax: 636-625-4777
Mailing address:
  • Phone: 314-725-0192
  • Fax: 314-725-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number01078500
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number109431
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01078500A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: