MEDICARE: NIDA ANSARI

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	207R00000X	Internal Medicine Physician	2025029344	MO

General Provider Information

NPI Number	:	1861142408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDA ANSARI

Provider Business Mailing Address
First Line	:	1008 S SPRING AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-2520
Country	:	US
Telephone Number	:	314-257-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1016
Country	:	US
Telephone Number	:	314-257-8000
Fax Number	:

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

Provider Enumeration Date	:	03/26/2022
Last Update Date	:	01/23/2026

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Directions to “ NIDA ANSARI ” Practice Location

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