Healthcare Provider Details

I. General information

NPI: 1639811334
Provider Name (Legal Business Name): BISMA BADR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. BISMA BADR

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date: 01/03/2023
Reactivation Date: 01/31/2023

III. Provider practice location address

WUSM PEDS 1 CHILDRENS PL MSC 8116-0043-09
ST. LOUIS MO
63110
US

IV. Provider business mailing address

WUSM PEDS 1 CHILDRENS PL MSC 8116-0043-09
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2341
  • Fax: 314-454-4345
Mailing address:
  • Phone: 314-454-2341
  • Fax: 314-454-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025026523
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: