Healthcare Provider Details

I. General information

NPI: 1356381438
Provider Name (Legal Business Name): MUNIR AHMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD
SAINT LOUIS MO
63117-1811
US

IV. Provider business mailing address

PO BOX 503945
SAINT LOUIS MO
63150-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8000
  • Fax: 314-768-8011
Mailing address:
  • Phone: 314-989-0300
  • Fax: 314-810-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number33036
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: