Healthcare Provider Details

I. General information

NPI: 1346093804
Provider Name (Legal Business Name): MOHAMMAD HESAM ALAVI MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1016
US

IV. Provider business mailing address

CLEVELAND CLINIC 9500 EUCLID AVENUE/JJ24
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-2809
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2025031723
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.256622
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: