Healthcare Provider Details

I. General information

NPI: 1083388425
Provider Name (Legal Business Name): OMAYMAH MOHAMMAD ABD ALKARIM AL OTOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 06/28/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE STE 2600
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1700
  • Fax:
Mailing address:
  • Phone: 314-286-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number202402458
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: