Healthcare Provider Details

I. General information

NPI: 1730718552
Provider Name (Legal Business Name): NADIA MUKTAR GIDIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV OBGYN MFM AND ULTRASOUND
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8181
  • Fax: 314-747-1429
Mailing address:
  • Phone: 314-454-8181
  • Fax: 314-747-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberW5346
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: