Healthcare Provider Details

I. General information

NPI: 1093727471
Provider Name (Legal Business Name): ST. LOUIS PSYCHIATRY DOCTORS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 MIAMI ST
SAINT LOUIS MO
63118-3929
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-6195
  • Fax: 314-268-6155
Mailing address:
  • Phone: 314-872-1439
  • Fax: 314-810-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number2006014089
License Number StateMO

VIII. Authorized Official

Name: DR. MUHAMMAD ARAIN
Title or Position: OWNER/MEDICAL DOCTOR
Credential:
Phone: 314-268-6195