Healthcare Provider Details

I. General information

NPI: 1902280704
Provider Name (Legal Business Name): FARZANA HOQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 03/18/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

GIM, 2ND FLOOR 1008 SOUTH SPRING
ST. LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8222
  • Fax: 314-577-8019
Mailing address:
  • Phone: 314-257-8222
  • Fax: 314-577-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2018023721
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: