Healthcare Provider Details

I. General information

NPI: 1528449527
Provider Name (Legal Business Name): ALI J KHIABANI M.D., M.H.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
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: 314-362-7260
  • Fax: 888-272-2816
Mailing address:
  • Phone: 314-362-7260
  • Fax: 888-272-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2017004409
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: