Healthcare Provider Details

I. General information

NPI: 1639752512
Provider Name (Legal Business Name): SYED BASAR RIZVI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 BUTLER HILL RD STE B
SAINT LOUIS MO
63128-3718
US

IV. Provider business mailing address

1703 TRINITY CIRCLE
ARNOLD MO
63010-2652
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-9009
  • Fax: 314-849-9004
Mailing address:
  • Phone: 309-287-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2024008263
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: