Healthcare Provider Details

I. General information

NPI: 1942695937
Provider Name (Legal Business Name): ELDIN DUDERIJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S NEW BALLAS RD STE 2030
SAINT LOUIS MO
63141-8253
US

IV. Provider business mailing address

625 S NEW BALLAS RD STE 2030
SAINT LOUIS MO
63141-8253
US

V. Phone/Fax

Practice location:
  • Phone: 314-283-6029
  • Fax:
Mailing address:
  • Phone: 314-251-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2018004998
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: