MEDICARE: FAWWAZ HUSAM ALMAJALI MD

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

General Provider Information

NPI Number	:	1205497070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWWAZ HUSAM ALMAJALI MD

Provider Business Mailing Address
First Line	:	7342 BALSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2901
Country	:	US
Telephone Number	:	314-662-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAINT LOUIS UNIVERSITY,1438 SOUTH GRAND BLVD.ST. LOUIS,
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-6313
Country	:	US
Telephone Number	:	314-977-4830
Fax Number	:

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/24/2019

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