Healthcare Provider Details

I. General information

NPI: 1982807335
Provider Name (Legal Business Name): SHAFIA M BHUTTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 4005B
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 4005B
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-5016
  • Fax: 314-567-1846
Mailing address:
  • Phone: 314-567-5016
  • Fax: 314-567-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2007008450
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: