Healthcare Provider Details

I. General information

NPI: 1376546804
Provider Name (Legal Business Name): NADEEM AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CRAIG RD STE 130
SAINT LOUIS MO
63141-7133
US

IV. Provider business mailing address

777 CRAIG RD STE 130
SAINT LOUIS MO
63141-7133
US

V. Phone/Fax

Practice location:
  • Phone: 314-473-6183
  • Fax: 314-552-7579
Mailing address:
  • Phone: 314-473-6183
  • Fax: 314-552-7579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberR4P08
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberR4P08
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: