Healthcare Provider Details

I. General information

NPI: 1053807222
Provider Name (Legal Business Name): MUHAMMAD SOHAIB AFZAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S NEW BALLAS RD STE 7020
SAINT LOUIS MO
63141-8218
US

IV. Provider business mailing address

625 S NEW BALLAS RD STE 7020
SAINT LOUIS MO
63141-8218
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6486
  • Fax: 314-251-4155
Mailing address:
  • Phone: 314-251-6486
  • Fax: 314-251-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2025016079
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number327233
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: