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General NPI Number Information
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NPI Number | 1417367244
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Entity Type | Individual
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Provider Name | AMEESH DARA D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 777 S NEW BALLAS RD STE 328W
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8748
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Country | US
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Telephone | 314-869-0370
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Fax | 314-869-5098
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Provider Business Mailing Address
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Address Line | 1234 LAY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1872
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Country | US
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Telephone | 314-456-6659
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036.148828
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 2019015695
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License Number State | MO
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