Healthcare Provider Details

I. General information

NPI: 1861408650
Provider Name (Legal Business Name): GATEWAY HEALTHCARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7491 BIG BEND BLVD
WEBSTER GROVES MO
63119-2101
US

IV. Provider business mailing address

PO BOX 2153 DEPT 30704
BIRMINGHAM AL
35287-9257
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-3038
  • Fax: 314-961-6731
Mailing address:
  • Phone: 314-961-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MAHRUKH KHAN
Title or Position: CEO
Credential: M.D.
Phone: 314-961-3038