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General NPI Number Information
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NPI Number | 1144419144
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Entity Type | Individual
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Provider Name | TARIQ JAWAID ALAM MD, FAAN
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Gender | Male
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1400 US HIGHWAY 61, SOUTH, SUITE 120
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City | FESTUS
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State | MO
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Zip | 63028
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Country | US
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Telephone | 636-933-8270
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Fax | 636-933-1233
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Provider Business Mailing Address
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Address Line | 1400 US HIGHWAY 61, SOUTH, SUITE 120
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City | FESTUS
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State | MO
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Zip | 63028
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Country | US
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Telephone | 636-933-8270
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Fax | 636-933-1233
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 74608
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 2012015951
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License Number State | MO
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