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General NPI Number Information
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NPI Number | 1518337815
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY MEDICAL CONSULTANTS, P.C.
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 2 MEMORIAL DR SUITE 202
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City | ALTON
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State | IL
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Zip | 62002-6723
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Country | US
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Telephone | 618-462-2359
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Fax | 618-462-2398
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Provider Business Mailing Address
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Address Line | PO BOX 7686
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City | CHESTERFIELD
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State | MO
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Zip | 63006-7686
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Country | US
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Telephone | 618-462-2359
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Fax | 618-462-2398
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Authorized Official
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Title or Position | MD/OWNER
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Name | AHMAD KARADAGHY
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Credential | MD
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Telephone | 618-462-2359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036100455
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License Number State | IL
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