MEDICARE: DR. MOHAMMED AL-ZOUBAIDI M.D

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2086S0129X	Vascular Surgery Physician	036137242	IL

General Provider Information

NPI Number	:	1063606432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED AL-ZOUBAIDI M.D

Provider Business Mailing Address
First Line	:	PO BOX 955860
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-1105
Country	:	US
Telephone Number	:	636-498-5944
Fax Number	:	618-529-0568

Provider Business Practice Location Address
First Line	:	2 GOOD SAMARITAN WAY STE 220
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2476
Country	:	US
Telephone Number	:	618-899-3900
Fax Number	:	618-529-0556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	10/19/2020

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