Healthcare Provider Details

I. General information

NPI: 1750310439
Provider Name (Legal Business Name): AMAL F ANTOUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMAL F GHALY

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 BIDDLE ST
SAINT LOUIS MO
63106-3454
US

IV. Provider business mailing address

PO BOX 551
SAINT LOUIS MO
63188-0551
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8531
  • Fax: 314-814-8542
Mailing address:
  • Phone: 314-814-8531
  • Fax: 314-814-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMO 36283
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: