MEDICARE: RASHID A DALAL MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG1905	OTHER		RR MEDICARE
3	110184061	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053390484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RASHID A DALAL MD PC

Provider Business Mailing Address
First Line	:	7 BEAVER CREEK CT
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5497
Country	:	US
Telephone Number	:	618-239-9500
Fax Number	:	618-239-9555

Provider Business Practice Location Address
First Line	:	5003 N ILLINOIS ST STE 1
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-3419
Country	:	US
Telephone Number	:	618-239-9500
Fax Number	:	618-239-9555

Authorized Official
Title or Position	:	MD
Name	:	DR. RASHID A DALAL
Credential	:	MD
Telephone Number	:	618-239-9500

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	08/12/2024

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