Healthcare Provider Details

I. General information

NPI: 1639741218
Provider Name (Legal Business Name): MOH'D RAWHI ABU HAMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-09
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-09
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6173
  • Fax: 314-454-2412
Mailing address:
  • Phone: 314-454-6173
  • Fax: 314-454-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024012598
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-12283
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024025972
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: