Healthcare Provider Details

I. General information

NPI: 1497000194
Provider Name (Legal Business Name): SIDDIQ ANWAR MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE # 8129 RENAL FELLOWSHIP PROGRAM
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

24 THE BOULEVARD SAINT LOUIS # 201
SAINT LOUIS MO
63117-1123
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7211
  • Fax: 314-747-3743
Mailing address:
  • Phone: 314-475-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2012021715
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: