Healthcare Provider Details

I. General information

NPI: 1184689549
Provider Name (Legal Business Name): ALI ZIAEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD SUITE 204
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

11125 DUNN RD SUITE 204
SAINT LOUIS MO
63136-6132
US

V. Phone/Fax

Practice location:
  • Phone: 314-839-5522
  • Fax: 314-839-5351
Mailing address:
  • Phone: 314-839-5522
  • Fax: 314-839-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-113041
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number110457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: