MEDICARE: DR. ALI AKBAR MEHDIRAD 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	207RC0001X	Clinical Cardiac Electrophysiology Physician	R5G76	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH4229	OTHER	MO	RR MEDICARE GROUP#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	431908828	OTHER	MO	TAX ID#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093770257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI AKBAR MEHDIRAD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 952273
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-2273
Country	:	US
Telephone Number	:	314-432-2580
Fax Number	:	314-432-0223

Provider Business Practice Location Address
First Line	:	777 S NEW BALLAS RD
Second Line	:	SUITE 300E
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8705
Country	:	US
Telephone Number	:	314-432-7839
Fax Number	:	314-432-4839

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/13/2009

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