Healthcare Provider Details

I. General information

NPI: 1417114141
Provider Name (Legal Business Name): SHAFKAT ANWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL STE C STE C
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

3333 CALIFORNIA ST S1-10
SAN FRANCISCO CA
94118
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6095
  • Fax: 314-454-2561
Mailing address:
  • Phone: 415-885-7268
  • Fax: 415-885-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013021434
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC157657
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberC157657
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number2013021434
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: