Healthcare Provider Details

I. General information

NPI: 1154828788
Provider Name (Legal Business Name): ANUM N QADRI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S BRENTWOOD BLVD
SAINT LOUIS MO
63144-1320
US

IV. Provider business mailing address

1600 S BRENTWOOD BLVD
SAINT LOUIS MO
63144-1320
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MB11924400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2025027692
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: