Healthcare Provider Details

I. General information

NPI: 1447237904
Provider Name (Legal Business Name): NABIL H TAUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD SUITE 103A
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

10004 KENNERLY RD SUITE 103A
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5235
  • Fax: 314-543-5216
Mailing address:
  • Phone: 314-543-5235
  • Fax: 314-543-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR7A06
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: