Healthcare Provider Details

I. General information

NPI: 1194897207
Provider Name (Legal Business Name): HELAL EKRAMUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 NETHERTON DR
SAINT LOUIS MO
63136-4649
US

IV. Provider business mailing address

PO BOX 66980
SAINT LOUIS MO
63166-6980
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-2700
  • Fax: 314-355-2720
Mailing address:
  • Phone: 314-878-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2001014922
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: