=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851341366
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHALID NASEER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 SAINT ANTHONYS WAY STE 105
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62002-4580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-465-2761
-----------------------------------------------------
Fax | 618-465-4750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 SAINT ANTHONYS WAY STE 105
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62002-4580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-465-2761
-----------------------------------------------------
Fax | 618-465-4750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 2007001669
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 036121860
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------