Healthcare Provider Details

I. General information

NPI: 1336897982
Provider Name (Legal Business Name): TALAH BAKDASH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD STE 1120
SAINT LOUIS MO
63117-1211
US

IV. Provider business mailing address

1034 S BRENTWOOD BLVD STE 1120
SAINT LOUIS MO
63117-1211
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-3001
  • Fax:
Mailing address:
  • Phone: 314-617-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP06031
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: