Healthcare Provider Details

I. General information

NPI: 1821075672
Provider Name (Legal Business Name): MOHAMMAD ASIF WAZIRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 GERORGIA ST
LOUISIANA MO
63353
US

IV. Provider business mailing address

147 GEMINI DR
HANNIBAL MO
63401-2389
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5531
  • Fax:
Mailing address:
  • Phone: 573-248-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2001010816
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2001010816
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: