Healthcare Provider Details

I. General information

NPI: 1811003890
Provider Name (Legal Business Name): IBRAHIM SULEMAN UMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N CLOVERLEAF DR SUITE N
SAINT PETERS MO
63376-6436
US

IV. Provider business mailing address

97 GREEN NUMBER 10 DR
SAINT CHARLES MO
63303-5093
US

V. Phone/Fax

Practice location:
  • Phone: 636-922-9182
  • Fax: 636-922-9183
Mailing address:
  • Phone: 636-946-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR8426
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: