Healthcare Provider Details

I. General information

NPI: 1720055452
Provider Name (Legal Business Name): INFECTIOUS DISEASES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY ROAD #171B
ST. LOUIS MO
63128
US

IV. Provider business mailing address

10004 KENNERLY ROAD #171B
ST. LOUIS MO
63128
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-0900
  • Fax: 800-556-8932
Mailing address:
  • Phone: 314-821-0900
  • Fax: 800-556-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: AAMINA B AKHTAR
Title or Position: PRESIDENT
Credential: MD
Phone: 314-821-0900