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General NPI Number Information
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NPI Number | 1366428286
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Entity Type | Individual
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Provider Name | SYED K IMAM MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 200 PORTLAND ST
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City | COLUMBIA
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State | MO
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Zip | 65201-6525
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Country | US
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Telephone | 844-853-8937
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 COMMUNITY
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City | CLINTON
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State | MO
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Zip | 64735-8804
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Country | US
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Telephone | 660-885-8131
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2001021520
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E-19220
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 45466
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C161906
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2001021520
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License Number State | MO
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