Healthcare Provider Details

I. General information

NPI: 1851208177
Provider Name (Legal Business Name): ZIAUDDIN AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HIGHLANDS PLAZA DR APT 1052
SAINT LOUIS MO
63110-1382
US

IV. Provider business mailing address

5700 HIGHLANDS PLAZA DR APT 1052
SAINT LOUIS MO
63110-1382
US

V. Phone/Fax

Practice location:
  • Phone: 630-501-4947
  • Fax:
Mailing address:
  • Phone: 630-501-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2026010266
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: