MEDICARE: DR. RASHID AHMED DALAL 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	207RN0300X	Nephrology Physician	MD103192	MO
2	207RN0300X	Nephrology Physician	036090043	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110184061	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	286639	OTHER		HEALTHLINK PPO HMO WC
2	8226186	OTHER	IL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	110483	OTHER		BCBS CHOICE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	38137	OTHER		GHP SENSICARE ACCESS, CMR
8	2369786	OTHER		AETNA PRUDENTIAL
9	3100008 NEPH	OTHER		UNITED HEALTHCARE
10	816M2	OTHER	MO	BCBS ALLIANCE

General Provider Information

NPI Number	:	1265434815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RASHID AHMED DALAL MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	04/30/2024

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