Healthcare Provider Details

I. General information

NPI: 1093770257
Provider Name (Legal Business Name): ALI AKBAR MEHDIRAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S NEW BALLAS RD SUITE 300E
SAINT LOUIS MO
63141-8705
US

IV. Provider business mailing address

PO BOX 952273
SAINT LOUIS MO
63195-2273
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-7839
  • Fax: 314-432-4839
Mailing address:
  • Phone: 314-432-2580
  • Fax: 314-432-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberR5G76
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: