1194897207 NPI number — DR. HELAL EKRAMUDDIN M.D.

Table of content: DR. HELAL EKRAMUDDIN M.D. (NPI 1194897207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194897207 NPI number — DR. HELAL EKRAMUDDIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EKRAMUDDIN
Provider First Name:
HELAL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194897207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63166-6980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-878-0163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2870 NETHERTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-4649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-355-2700
Provider Business Practice Location Address Fax Number:
314-355-2720
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2001014922 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 205434319 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 955295618 . This is a "MEDICARE IND#" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000015618 . This is a "MEDICARE GRP #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".