Healthcare Provider Details

I. General information

NPI: 1639564776
Provider Name (Legal Business Name): FANG BAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 07/06/2026
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N NEW BALLAS CT DIV NEUROLOGY COMMUNITY, STE 202
SAINT LOUIS MO
63141-7134
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 557-747-2529
  • Fax: 314-371-4704
Mailing address:
  • Phone: 557-747-2529
  • Fax: 314-371-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2019005006
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: