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General NPI Number Information
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NPI Number | 1043754039
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Entity Type | Individual
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Provider Name | TARIQ HALASA MD
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Gender | Male
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3015 N BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2329
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Country | US
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Telephone | 314-996-5772
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Fax |
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Provider Business Mailing Address
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Address Line | 232 S WOODS MILL RD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3485
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Country | US
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Telephone | 314-434-1500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2021026797
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 2021026797
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 25MA12122800
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License Number State | NJ
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