Healthcare Provider Details

I. General information

NPI: 1366071433
Provider Name (Legal Business Name): AISHA ZIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-2650
  • Fax: 314-768-6602
Mailing address:
  • Phone: 314-617-2650
  • Fax: 314-768-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2024011190
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: