1811003890 NPI number — DR. IBRAHIM SULEMAN UMAR M.D.

Table of content: DR. IBRAHIM SULEMAN UMAR M.D. (NPI 1811003890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811003890 NPI number — DR. IBRAHIM SULEMAN UMAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UMAR
Provider First Name:
IBRAHIM
Provider Middle Name:
SULEMAN
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:
1811003890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97 GREEN NUMBER 10 DR
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:
63303-5093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-946-8152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 N CLOVERLEAF DR
Provider Second Line Business Practice Location Address:
SUITE N
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-6436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-922-9182
Provider Business Practice Location Address Fax Number:
636-922-9183
Provider Enumeration Date:
08/22/2006

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: 208000000X , with the licence number:  R8426 , 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)





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