MEDICARE: MALAZ SAFI, M.D., P.C.

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	207W00000X	Ophthalmology Physician	336-031037	IL
2	207W00000X	Ophthalmology Physician	R9B71	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DD3116	OTHER	MO	RAILROAD MEDICARE
5	DC5331	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0269280001	OTHER	IL	NATIONAL GOVERNMENT SERVI

General Provider Information

NPI Number	:	1255543047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALAZ SAFI, M.D., P.C.

Provider Business Mailing Address
First Line	:	8790 WATSON RD STE 203
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5140
Country	:	US
Telephone Number	:	314-543-2850
Fax Number	:	314-543-2851

Provider Business Practice Location Address
First Line	:	8790 WATSON RD STE 203
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5140
Country	:	US
Telephone Number	:	314-543-2850
Fax Number	:	314-543-2851

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MALAZ SAFI
Credential	:	M.D.
Telephone Number	:	314-543-2850

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	01/11/2012

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