Healthcare Provider Details

I. General information

NPI: 1457989071
Provider Name (Legal Business Name): SIDDIQUE TANZEEM AKRAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 359C
SAINT LOUIS MO
63131-2324
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-3520
  • Fax: 314-996-3525
Mailing address:
  • Phone: 314-996-3520
  • Fax: 314-996-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2026033405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: