Healthcare Provider Details

I. General information

NPI: 1134534621
Provider Name (Legal Business Name): DANIEL M HAFEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 04/17/2025
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12634 OLIVE BLVD DEPT NEUROLOGICAL SURGERY
SAINT LOUIS MO
63141-6337
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3577
  • Fax: 314-362-2107
Mailing address:
  • Phone: 314-362-3577
  • Fax: 314-362-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2018025914
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: