MEDICARE: ASAD QAYUM 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	207L00000X	Anesthesiology Physician	101978	MO

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

General Provider Information

NPI Number	:	1427043041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASAD QAYUM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 22407
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-0407
Country	:	US
Telephone Number	:	636-386-7222
Fax Number	:	636-200-4036

Provider Business Practice Location Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	636-386-7222
Fax Number	:	636-200-4036

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	12/30/2014

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