1265434815 NPI number — DR. RASHID AHMED DALAL MD

Table of content: (NPI 1679700843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265434815 NPI number — DR. RASHID AHMED DALAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALAL
Provider First Name:
RASHID
Provider Middle Name:
AHMED
Provider Name Prefix Text:
DR.
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:
1265434815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 BEAVER CREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63303-5497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-239-9500
Provider Business Mailing Address Fax Number:
618-239-9555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5003 N ILLINOIS ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRVIEW HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62208-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-239-9500
Provider Business Practice Location Address Fax Number:
618-239-9555
Provider Enumeration Date:
08/12/2005

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: 207RN0300X , with the licence number:  MD103192 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 036090043 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 286639 . This is a "HEALTHLINK PPO HMO WC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8226186 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036090043 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110184061 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110483 . This is a "BCBS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203771902 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38137 . This is a "GHP SENSICARE ACCESS, CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2369786 . This is a "AETNA PRUDENTIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3100008 NEPH . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 816M2 . This is a "BCBS ALLIANCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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