Healthcare Provider Details

I. General information

NPI: 1730708033
Provider Name (Legal Business Name): MARIAM SHABBIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date: 01/10/2022
Reactivation Date: 01/27/2022

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 Number2025001461
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: