Healthcare Provider Details

I. General information

NPI: 1225088891
Provider Name (Legal Business Name): OBEID NOOR ILAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DIV SURG ACCS, STE 420
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5298
  • Fax: 888-824-2176
Mailing address:
  • Phone: 314-362-5298
  • Fax: 888-824-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2014032444
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number2014032444
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2014032444
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: