Healthcare Provider Details

I. General information

NPI: 1457864175
Provider Name (Legal Business Name): AMBER MAHMOOD BOKHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 295B
SAINT LOUIS MO
63128-2177
US

IV. Provider business mailing address

10004 KENNERLY RD
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-791-1108
  • Fax: 314-375-5020
Mailing address:
  • Phone: 314-740-2949
  • Fax: 314-375-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2026011870
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberL.5083SP
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: