Healthcare Provider Details

I. General information

NPI: 1578185989
Provider Name (Legal Business Name): FERAS KAID PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 04/03/2026
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S KINGSHIGHWAY BLVD DEPT RADIOLOGY, STE G15
SAINT LOUIS MO
63110-1016
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-2900
  • Fax: 314-362-2276
Mailing address:
  • Phone: 314-362-2900
  • Fax: 314-362-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2025004836
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: