1386658235 NPI number — ANJUM SHARIFF MD

Table of content: ANJUM SHARIFF MD (NPI 1386658235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386658235 NPI number — ANJUM SHARIFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARIFF
Provider First Name:
ANJUM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1386658235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 FOXRIDGE DR
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66202-2338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-261-3153
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11133 DUNN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-653-4300
Provider Business Practice Location Address Fax Number:
314-821-2180
Provider Enumeration Date:
07/28/2006

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: 2085R0202X , with the licence number:  2001008548 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 036105031 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1601682 . This is a "PH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205298409 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300121429 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431725842MID . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 46069 . This is a "HCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1390 . This is a "MO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2781 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00053279 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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