Healthcare Provider Details

I. General information

NPI: 1215824271
Provider Name (Legal Business Name): ARSALAN ALI KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 NASH WAY
SAINT LOUIS MO
63110-1020
US

IV. Provider business mailing address

4466 OLIVE ST APT 105
SAINT LOUIS MO
63108-1853
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8087
  • Fax:
Mailing address:
  • Phone: 773-640-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number2025024174
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2025024174
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2025024174
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: