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General NPI Number Information
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NPI Number | 1306132196
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Entity Type | Individual
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Provider Name | IMRAN HAIDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 10010 KENNERLY RD 3 SOUTHBRIDGE
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 314-525-1328
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Fax | 314-525-1378
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Provider Business Mailing Address
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Address Line | 10010 KENNERLY RD 3 SOUTHBRIDGE
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 314-525-1328
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Fax | 314-525-1378
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9003635-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | BP10054986
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2014021221
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License Number State | MO
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