Healthcare Provider Details

I. General information

NPI: 1386658235
Provider Name (Legal Business Name): ANJUM SHARIFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD
ST LOUIS MO
63136
US

IV. Provider business mailing address

5800 FOXRIDGE DR STE 240
MISSION KS
66202-2338
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-4300
  • Fax: 314-821-2180
Mailing address:
  • Phone: 913-261-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2001008548
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036105031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: