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General NPI Number Information
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NPI Number | 1093770257
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Entity Type | Individual
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Provider Name | ALI AKBAR MEHDIRAD M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/13/2009
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Provider Practice Location Address
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Address Line | 777 S NEW BALLAS RD SUITE 300E
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8705
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Country | US
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Telephone | 314-432-7839
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Fax | 314-432-4839
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Provider Business Mailing Address
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Address Line | PO BOX 952273
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City | SAINT LOUIS
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State | MO
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Zip | 63195-2273
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Country | US
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Telephone | 314-432-2580
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Fax | 314-432-0223
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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 | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | R5G76
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License Number State | MO
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