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NPI Code Detail

MEDICARE: IMRAN HANAFI MD

MEDICARE: IMRAN HANAFI 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
1207R00000XInternal Medicine Physician2004001451MO
2208M00000XHospitalist Physician2004001451MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588637516
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMRAN HANAFI MD
Provider Business Mailing Address
First Line : 12101 WOODCREST EXECUTIVE DR
Second Line : SUITE 210
City : SAINT LOUIS
State : MO
Zip : 63141-5047
Country : US
Telephone Number : 314-317-0600
Fax Number : 314-317-0606
Provider Business Practice Location Address
First Line : 12303 DEPAUL DR
Second Line :
City : BRIDGETON
State : MO
Zip : 63044-2512
Country : US
Telephone Number : 314-317-0600
Fax Number : 314-317-0606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 05/08/2014

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Directions to “ IMRAN HANAFI MD” Practice Location

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