=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326266651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARAKA OBSTETRICS AND GYNECOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6125 CLAYTON AVE STE. 103
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63139-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-645-2008
-----------------------------------------------------
Fax | 314-645-1104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6125 CLAYTON AVE SUITE 103
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63139-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-645-2008
-----------------------------------------------------
Fax | 314-645-1104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. HAIFAA TAWFIQ YOUNIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 314-645-2008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 105526
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------