Healthcare Provider Details

I. General information

NPI: 1407801442
Provider Name (Legal Business Name): MEHRDAD JOHN SEHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MEHRDAD SEHIZADEH MD

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-2170
  • Fax:
Mailing address:
  • Phone: 314-257-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36111642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: