Healthcare Provider Details

I. General information

NPI: 1831333905
Provider Name (Legal Business Name): ALIASGAR HUSAINI DALAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD STE 301
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-5095
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-8250
  • Fax: 314-953-8255
Mailing address:
  • Phone: 314-953-8250
  • Fax: 314-953-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD61111853
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2021039677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: