Healthcare Provider Details

I. General information

NPI: 1578749792
Provider Name (Legal Business Name): KHALED ABDEL-HAMID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 W CLAY ST SUITE K
SAINT CHARLES MO
63301-2540
US

IV. Provider business mailing address

2745 W CLAY ST SUITE K
SAINT CHARLES MO
63301-2540
US

V. Phone/Fax

Practice location:
  • Phone: 636-940-0333
  • Fax: 636-940-0331
Mailing address:
  • Phone: 636-940-0333
  • Fax: 636-940-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number2000170148
License Number StateMO

VIII. Authorized Official

Name: DR. KHALED M. ABDEL-HAMID
Title or Position: OWNER
Credential: M.D., PH.D
Phone: 636-940-0333