Healthcare Provider Details

I. General information

NPI: 1598106874
Provider Name (Legal Business Name): MOMINA SOUDAGAR TURKEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1225 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4828
  • Fax: 314-977-4880
Mailing address:
  • Phone: 314-977-4828
  • Fax: 314-977-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2017009658
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: