Healthcare Provider Details

I. General information

NPI: 1538173174
Provider Name (Legal Business Name): FAQUIR MUHAMMUD, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD STE 206E
SAINT LOUIS MO
63136-6150
US

IV. Provider business mailing address

11155 DUNN RD STE 206E
SAINT LOUIS MO
63136-6150
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-6700
  • Fax: 314-355-6820
Mailing address:
  • Phone: 314-355-6700
  • Fax: 314-355-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberR8808
License Number StateMO

VIII. Authorized Official

Name: DR. FAQUIR MUHAMMUD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-355-6700